Impact of Onset-to-Needle Time on the Risk of Early Neurological Deterioration in Patients with Acute Ischemic Stroke Receiving Intravenous Thrombolysis.

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.