Benefit of thrombolysis for stroke is maintained around the clock: results from the SITS-EAST Registry.

BACKGROUND AND PURPOSE: The outcome of thrombolysis for early morning and sleep time strokes may be worse because of uncertainty of stroke onset time or differences in logistics. The aim of the study was to analyze if stroke outcome after intravenous thrombolysis differs depending on time of day when the stroke occurs. METHODS: The data collected in the Safe Implementation of Treatments in Stroke - Eastern Europe (SITS-EAST) Registry between September 2000 and December 2011 were used. Strokes were categorized as night-time 00:00-07:59, day-time 08:00-15:59 and evening-time 16:00-23:59 and were compared in terms of several outcome measures. All results were adjusted for baseline differences. RESULTS: A total of 8878 patients were enrolled: 18% had night-time, 54% day-time and 28% evening-time strokes. Onset-to-treatment time in patients with night-time strokes was 10 min longer than in day-time and evening-time strokes (P < 0.001). Symptomatic intracerebral hemorrhage by ECASS II definition occurred in 5.6%, 5.6% and 5.3% (adjusted P = 0.41) of the night-time, day-time and evening-time stroke patients, respectively; by SITS definition it occurred in 2.5%, 1.9% and 1.3% (adjusted P = 0.013) and by NINDS definition in 7.8%, 7.6% and 7.5% (adjusted P = 0.74). Patients with night-time, day-time and evening-time strokes achieved modified Rankin Scale score 0-1 in 33%, 31%, 31% (adjusted P = 0.34) and 0-2 in 52%, 51%, 50% (adjusted P = 0.23), and 13%, 15%, 16% respectively of patients died (adjusted P = 0.17) by 3 months. CONCLUSIONS: The time when stroke occurs (day versus evening versus night) does not affect the outcome after thrombolysis despite the fact that patients with night-time strokes have worse time management.

Long-term survival of young stroke patients: a population-based study of two stroke registries from tartu, estonia.

The aim of this paper was to evaluate the long-term survival of young stroke patients in Estonia, analyse time trends of survival, and compare the results with other studies. We have used 2 population-based first-ever stroke registry data (1991-1993 and 2001-2003) to analyse the 1-, 5-, and 7-year outcome of young stroke patients by the Kaplan-Meier method of analysis. From the group of 1206 patients, 129 (11%) were aged under 55 years. The overall survival rate at 1, 5, and 7 years was 0.70 (95% CI 0.62-0.78), 0.63 (95% CI 0.55-0.72), and 0.61 (95% CI 0.53-0.70), respectively. The survival was significantly worse for patients with intracerebral haemorrhage (P < 0.01) and for those aged from 45 to 54 years compared to the younger age group from 0 to 44 years (P = 0.03). For patients with ischemic stroke, aged from 15 to 44 years, the 1-, 5-, and 7-year survival rate was 0.89 (95% CI 0.79-1.00), 0.75 (95% CI 0.61-0.93), and 0.75 (0.61-0.93), respectively. There was no difference in overall survival between the two studied periods. We report a low long-term survival rate among young stroke patients in Estonia. Increasing age and hemorrhagic stroke subtype were associated with lower survival. We have previously shown a worse outcome for 1-year survival compared to other studies and currently this trend continues for 5- and 7-year survival rates. In fact, these are the lowest survival rates for the combined and separate stroke subtypes reported so far.

One-year outcome after first-ever stroke according to stroke subtype, severity, risk factors and pre-stroke treatment. A population-based study from Tartu, Estonia.

The aim of the current study was to evaluate the outcome at 1 year following a first-ever stroke based on a population-based registry from 2001 to 2003 in Tartu, Estonia. The outcome of first-ever stroke was assessed in 433 patients by stroke risk factors, demographic data and stroke severity at onset using the Barthel Index (BI) score and the modified Rankin Score (mRS) at seventh day, 6 months and 1 year. Female sex, older age, blood glucose value >10 mmol/l on admission and more severe stroke on admission were the best predictors of dependency 1 year following the first-ever stroke. At 1 year, the percentage of functionally dependent patients was 20% and the survival rate was 56%. The use of antihypertensive/antithrombotic medication prior to stroke did not significantly affect the outcome. The survival rate of stroke patients in Tartu is lower compared with other studied populations. The outcome of stroke was mainly determined by the initial severity of stroke and by elevated blood glucose value on admission. Patients with untreated hypertension had more severe stroke and trend for unfavourable outcome compared with those who were on treatment.

The Third Stroke Registry in Tartu, Estonia, from 2001 to 2003.

OBJECTIVES: The main goal of the Third Stroke Registry in Tartu was to determine the incidence and 28-day case-fatality of first-ever stroke in an Estonian population. SUBJECTS AND METHODS: Stroke registry was conducted from 1 December 2001 to 30 November 2003. RESULTS: The registry included 451 patients. The incidence rate of first-ever stroke age-standardized to the European population was 188/100,000. Among younger patients, the rates for men dominated. The incidence among men aged 0-44 years was 18/100,000, for women 9/100,000. In the age group 45-54 years, the corresponding rates were 143/100,000 and 98/100,000 respectively. The overall 28-day case-fatality rate was 26%. CONCLUSIONS: The total stroke incidence in Tartu is comparable with other European studies, but the rates for younger patients are higher. This may be associated with lower quality of life, less attention to public health, high prevalence and/or poor control of stroke risk factors. The 28-day case-fatality is somewhat higher than in other European centres.