Positive impact of the participation in the ENCHANTED trial in reducing Door-to-Needle Time.
Positive impact of the participation in the ENCHANTED trial in reducing Door-to-Needle Time.
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参与 ENCHANTED 试验对减少就诊至就针时间的积极影响
DOI：
10.1038/s41598-017-14164-8
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发表时间：
2017-10-26
影响因子：
4.6
通讯作者：
Chalmers J
中科院分区：
文献类型：
--
作者：
Yang J;Wang X;Yu JP;Hang J;Lavados P;Robinson T;Arima H;Lindley RI;Anderson CS;Chalmers J
门到针时间（DNT）是在急性缺血性卒中（AIS）中有效使用静脉溶栓的关键性能指标。我们的目的是确定在高血压和急性卒中强化控制研究（ENCHANTED）中DNT是否随着时间的推移而改善以及DNT的临床预测因素。使用广义线性模型评估了自研究中心启动以来四分之一时间内DNT的时间趋势。在逻辑回归模型中确定长DNT（>60分钟）的预测因子。总体平均DNT（min）为71.8（95%置信区间[CI] 70.4-73.2），但随时间推移显著降低（四分之一）：77.9（74.9-80.9）、69.3（66.7-72.0）、69.1（66.5-71.8）和71.4（68.7-74.2）（趋势P，0.003）。中国的DNT降低尤其显著（P趋势，0.001），但在其他参与国家中并不显著（P趋势，0.065）。长期DNT的独立预测因素是从中国招募、发病至入院时间短、每个中心接受治疗的患者数量较少、舒张压较高、非工作时间入院和无近端血栓闭塞。ENCHANTED的DNT在试验期间逐渐下降，尤其是在中国。然而，中国的DNT仍长于指南中推荐的关键性能参数≤60分钟。中国需要有效的国家计划来改善DNT。
Door-to-needle time (DNT) is a key performance indicator for efficient use of intravenous thrombolysis in acute ischemic stroke (AIS). We aimed to determine whether DNT improved over time in the Enhanced Control of Hypertension and Acute Stroke Study (ENCHANTED) and the clinical predictors of DNT. Temporal trends in DNT were assessed across fourths of time since activation of study centers using generalized linear model. Predictors of long DNT (>60 min) were determined in logistic regression models. Overall mean DNT (min) was 71.8 (95% confidence interval [CI] 70.4–73.2), but decreased significantly over time (fourths): 77.9 (74.9–80.9), 69.3 (66.7–72.0), 69.1 (66.5–71.8) and 71.4 (68.7–74.2) (P for trend, 0.003). The reduction in DNT was particularly marked in China (P for trend, 0.001), but was not significant across the other participating countries (P for trend, 0.065). Independent predictors of long DNT were recruitment from China, short onset-to-door time, lower numbers of patients treated per center, higher diastolic blood pressure, off-hour admission, and absence of proximal clot occlusion. DNT in ENCHANTED declined progressively during the trial, especially in China. However, DNT in China is still longer than the key performance parameter of ≤60 minutes recommended in guidelines. Effective national programs are needed to improve DNT in China.
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影响因子：
8.3
作者：
Jauch, Edward C.;Saver, Jeffrey L.;Yonas, Howard
通讯作者：
Yonas, Howard
影响因子：
8.3
作者：
Ruff, Ilana M.;Ali, Syed F.;Schwamm, Lee H.
通讯作者：
Schwamm, Lee H.
影响因子：
8.3
作者：
Strbian, Daniel;Michel, Patrik;Tatlisumak, Turgut
通讯作者：
Tatlisumak, Turgut
影响因子：
120.7
作者：
Fonarow, Gregg C.;Zhao, Xin;Schwamm, Lee H.
通讯作者：
Schwamm, Lee H.
影响因子：
2.9
作者：
Hasegawa, Y;Yoneda, Y;Ibayashi, S
通讯作者：
Ibayashi, S