Bo Hu, Jiewei Hua

Department of Neurology, The Fifth Hospital of Wuhan, Wuhan, Hubei, People’s Republic of China

Correspondence: Bo Hu, Department of Neurology, The Fifth Hospital of Wuhan, No. 122 Xianzheng Street, Wuhan, Hubei, 430050, People’s Republic of China, Tel +86-19971987765, Email wiseeth@outlook.com

Objective: This study aimed to investigate the influence of onset-to-needle time (ONT) on early neurological deterioration (END) in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis.
Methods: Patients with AIS receiving intravenous thrombolysis at The Fifth Hospital of Wuhan between March 2021 and December 2023 were enrolled. Patients were divided into an END group (n=104) and a non-END group (n=317) based on a National Institutes of Health Stroke Scale (NIHSS) score increase of ≥ 4 points within 24 hours. Baseline and clinical data were analyzed using univariate, multivariable logistic regression, and subgroup analyses. A logistic regression model was developed to predict END, and its performance was assessed using receiver operating characteristic (ROC) curves.
Results: Univariate analysis revealed significant differences between groups in age, total cholesterol, low-density lipoprotein cholesterol (LDL-C), lipoprotein-associated phospholipase A2 (Lp-PLA2), white blood cell count, activated partial thromboplastin time (APTT), pre-admission NIHSS score, and ONT (all P< 0.05). Heart disease history, infarct location, and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification also differed significantly (all P< 0.05). Multivariable analysis identified age (Odds Ratio [OR]=1.098, 95% Confidence Interval [CI]:  1.031– 1.169, P=0.003), LDL-C (OR=2.785, 95% CI:  1.360– 5.710, P=0.005), Lp-PLA2 (OR=1.008, 95% CI:  1.001– 1.015, P=0.045), complete anterior circulation infarction (vs lacunar; OR=8.050, 95% CI:  5.180– 12.510, P=0.023), cardioembolic stroke (vs small vessel occlusion; OR=12.810, 95% CI:  8.420– 19.530, P=0.002), and ONT (OR=1.015, 95% CI:  1.002– 1.028, P=0.028) as independent risk factors for END. Subgroup analysis by admission NIHSS score showed that for moderate and severe strokes, each minute increase in ONT raised END risk by  1.5% (95% CI:  1.002– 1.028, P=0.031) and  3.0% (95% CI:  1.009– 1.052, P=0.005), respectively.
Conclusion: Prolonged ONT is an independent risk factor for END in AIS patients, particularly those with moderate to severe strokes. Prompt thrombolysis is crucial for mitigating neurological decline.

Keywords: onset-to-needle time, acute ischemic stroke, intravenous thrombolysis, early neurological deterioration, influencing factors