Effect of Time Delay on Reperfusion After Tenecteplase in an Extended Time Window: Analysis From the CHABLIS-T Trials.

IF 5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Heart Association Pub Date : 2025-06-17 Epub Date: 2025-06-11 DOI:10.1161/JAHA.124.040994

Lan Hong, Juehua Zhu, Zhijiao He, Xinru Wang, Siyuan Li, Xinyu Liu, Yifeng Ling, Lumeng Yang, Qi Fang, Qiang Dong, Xin Cheng

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引用次数: 0

Abstract

Background: The association between time and reperfusion in an extended time window remains unexplored. This study aimed to investigate whether time delay was associated with reduced odds of reperfusion in patients with acute ischemic stroke treated with tenecteplase in the 4.5- to 24-hour time window, in the CHABLIS-T (Chinese Acute Tissue-Based Imaging Selection for Lysis in Stroke-Tenecteplase) trials.

Methods: Patients from the CHABLIS-T and CHABLIS-T II trials treated with tenecteplase were included. Major reperfusion was assessed via follow-up perfusion imaging or digital subtraction angiography. Time intervals from symptom onset/last known well to hospital arrival/administration of tenecteplase were analyzed as continuous and categorical variables in multivariable logistic regression models. Subgroup analysis examined the consistency of the association across different patient characteristics.

Results: Sixty-seven patients achieved postthrombolytic major reperfusion among the 199 patients included. Longer onset-to-arrival time was associated with lower odds of major reperfusion (continuous: odds ratio [OR], 0.98 per 10 minutes, P=0.004; categorical: OR, 0.45, P=0.003). Similarly, prolonged onset-to-thrombolysis time was associated with decreased probability of reperfusion (continuous variable: OR, 0.98 per 10 minutes, P=0.01; categorical variable: OR, 0.48, P=0.002). The analysis of time from last known well drew similar results. Subgroup analysis revealed that patients with nonatherosclerotic stroke were more susceptible to time delay.

Conclusions: Time delay was associated with reduced postthrombolytic reperfusion odds in patients with stroke treated with tenecteplase, especially in nonatherosclerotic cases. Prompt reperfusion remains essential, even in patients with benign perfusion profiles in an extended time window.

Registration: URL: https://clinicalTrials.gov; URL: CHABLIS-T NCT04086147; CHABLIS-T II NCT04516993.

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时间延迟对延长时间窗内替奈普酶再灌注的影响：来自CHABLIS-T试验的分析。

背景：在延长的时间窗内，时间和再灌注之间的关系仍未被研究。在CHABLIS-T（中国卒中- tenecteplase溶解急性组织成像选择）试验中，本研究旨在探讨时间延迟是否与4.5- 24小时内接受tenecteplase治疗的急性缺血性卒中患者再灌注几率降低有关。方法：纳入接受替尼替普酶治疗的CHABLIS-T和CHABLIS-T II试验患者。通过随访灌注成像或数字减影血管造影评估主要再灌注。在多变量logistic回归模型中，以连续变量和分类变量分析从症状发作/最后一次已知到医院到达/给药的时间间隔。亚组分析检验了不同患者特征之间相关性的一致性。结果：199例患者中有67例实现了溶栓后再灌注。较长的发病至到达时间与较低的主要再灌注几率相关(连续：优势比[OR]， 0.98 / 10分钟，P=0.004；分类：OR， 0.45， P=0.003)。同样地，延长开始溶栓时间与再灌注概率降低相关(连续变量：OR， 0.98 / 10分钟，P=0.01；分类变量：OR， 0.48， P=0.002)。对上一口井的时间分析得出了类似的结果。亚组分析显示，非动脉粥样硬化性卒中患者更容易出现时间延迟。结论：在接受tenecteplase治疗的脑卒中患者中，时间延迟与溶栓后再灌注几率降低有关，尤其是在非动脉粥样硬化病例中。及时的再灌注仍然是必要的，即使是在延长的时间窗口内灌注表现良好的患者。注册：网址：https://clinicalTrials.gov；Url: chablis-t nct04086147；chablis ii nct04516993。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

1.90%

发文量

1749

审稿时长

12 weeks

期刊介绍： As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.