Interhospital transfer on intravenous thrombolysis in patients with acute ischemic stroke in three chinese municipal stroke centers

We included acute ischemic stroke (AIS) patients who received recombinant tissue plasminogen activator (rt-PA) at three stroke centers via either interhospital transfer or direct presentation and compared the clinical outcomes and time metrics to analyze the impact of interhospital transfer on intravenous thrombolysis (IVT). We retrospectively enrolled patients with AIS admitted to three stroke centers from October 1, 2016, to June 1, 2018. Patients treated with rt-PA were classified into the transfer and direct groups. We collected the patients' general information and time points. Statistical analyses were conducted to examine differences in the clinical outcomes and time metrics between the two groups. A total of 326 patients were enrolled, including 84 patients in the transfer group and 242 in the direct group. The transfer group had a longer onset-to-door time (OTD) (124.5 +/- 50.6 min versus 83.2 +/- 47.2 min, P < 0.01) but a shorter door-to-needle time (DNT) (53.0 +/- 26.3 min versus 81.5 +/- 31.1 min, P < 0.01), and the stroke onset-to-needle time was 177.4 +/- 51.0 min versus 164.7 +/- 53.3 min (P = 0.057). Compared with the direct group, the transfer group achieved similar modified Rankin scale (mRS) 0-2 outcomes (59.5% versus 58.7%, P = 0.768). Interhospital transfer was not an independent risk factor associated with a poor outcome at 90 days. In three Chinese municipal stroke centers, patients with an AIS referral have a longer OTD but a shorter DNT. DNTs of municipal hospitals were far longer than the current international standard, and their improvement is an important task.