What is the outcome of Door-to-needle Time within 60minutes for acute ischemic stroke patients treat with t-PA? Chi-Ching Chen 1, Hui-Fen Huang 1, Yu-Ling Hung 2, Yu-Yun Hsu 4, Han-Jung Lee 4, Chun-Hung Chen 3,4 1 Department of Nursing, Kaohsiung medical University Hospital, Kaohsiung medical University, Kaohsiung, Taiwan 2 Department of Nursing, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung medical University, Kaohsiung, Taiwan 3 Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan 4 Department of Neurology, Kaohsiung medical University Hospital, Kaohsiung medical University, Kaohsiung, Taiwan Table2. Clinical outcome between DTN with/without 60 minutes of acute ischemic stroke patients DTN(n) ≦ 1hr(n=40) ＞ 1hr(n=43) P-value O to N(min) 114.7± ± DTN(min) 45.28± ± △ NIHSS 5.68± ± Days(admission) 15.83± ± ICH SICH Mortality Spend(NT) ± ± post1mRS post3mRS post6mRS O to N: onset-to-needle time SICH: symptomatic intra-cranial hemorrhage Background The good outcome of intravenous tissue-type plasminogen activator (t-PA) in acute ischemic stroke (AIS) patients are time-dependent. Recent many stroke guidelines recommend door-to-needle time (DTN) must be within 60 minutes for AIS patients treated with t-PA. The aim of our study was to evaluate the clinical outcome associated with DTN time ≦ 60 minutes. Methods During 4-year study period (2010~2013), we enrolled 69 acute ischemic stroke patients treated with intravenous tissue plasminogen activator (iv-tPA) within 3 hours after symptom onset. Thirty-four patients administrated iv-tPA within 1 hour, and the other (35 patients) were treated more than 1 hour. Data collected were patients’ characteristics, tPA dosage, time points (stroke symptom onset, presentation to ED, neuroimaging and thrombolysis), clinical outcome (90 th days modified Rankin Scale (mRS), change of National Institute of Health Stroke Scale (NIHSS) at discharge, intracerebral hemorrhage (ICH) and death during admission), length of admission (LOA), and hospital cost. admission). Results Among 83 patients, only 40 (48.2%) DTN time was ≦ 60 minutes. Patient demographic factors, characteristics, clinical outcome and 30, 90,180-day mRS were no significant different when compared with and without DTN times ≦ 60 minutes. The mean time of DTN ≦ 60 minutes group was shorter (45.28 ±10.22 vs 91.09±22.98, p ＜ ), and the same result was found in mean time of onset-to-needle (OTN) (114.7±37.74 vs ±29.84, p=0.001). Conclusions Despite the guidelines recommend the rate of DTN time ≦ 60 minutes must be 50% at least in AIS patient treat with t- PA. It only near one-half of patient achieved this target over the past 4 years in our hospital. Our data cannot reveal significant good outcome for AIS patient treat with t-PA within 60 minutes. But, it is only a preliminary result of our study, we need more case number and longer period of observation time can prove the benefit of shortening DTN time for AIS patients. Reference 1. Gregg C. Fonarow, Eric E. Smith, Jeffrey L. Saver, et. Timeliness of Tissue- Type Plasminogen Activator Therapy in Acute Ischemic Stroke Patient Characteristics, Hospital Factors, and Outcomes Associated With Door-to-Needle Times Within 60 Minutes. Circulation. 2011;123: Greg g C. Fonarow, Xin Zhao, Eric E. Smith, et. Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative. JA M A. 2014;311(16): Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American. Stroke Association. Stroke 2013:1–8 Figure 1 Post-stroke 1mRS between DTN with/without 60 minutes Figure 2 Post-stroke 3mRS between DTN with/without 60 minutes Figure 3 Post-stroke 6mRS between DTN with/without 60 minutes Table 1. Characteristics of all acute ischemic stroke patients DTN(n) ≦ 1hr(n=40) ＞ 1hr(n=43) P-value Age(year) 62.35± ± Gender(F/M)15/2516/ Dosage mg/kg 0.82± ± Hypertension Diabetes Previons CVA / TIA Dyalipidemia Atrial fibrillation Heart disease O to ER(min)65.25± ± NIHSS (Admission) 13.65± ± DTN: door-to-needle time O to ER: onset-to-ER NIHSS: National Institute of Health Stroke Scale