Longer door-to-needle time is associated with the risk of post-stroke cognitive impairment after acute ischemic stroke: A retrospective study

Prolonged door-to-needle time (DNT) in stroke treatment has been associated with adverse clinical outcomes. However, its impact on post-stroke cognitive impairment (PSCI) remains underexplored. This study investigates the association between DNT and PSCI and evaluates the predictive value of DNT for cognitive dysfunction after acute ischemic stroke (AIS). This retrospective single-center study included 176 patients with AIS who received intravenous thrombolysis (IVT) between January 2021 and December 2024. The relationship between DNT and PSCI was assessed using multivariate logistic regression analysis, adjusting for stroke severity, infarct volume, stroke laterality, stroke circulation type, and vascular risk factors. Additionally, receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive performance of DNT for PSCI. Patients who developed PSCI had a significantly longer DNT compared to those without PSCI (63.7 ± 8.9 minutes vs 51.2 ± 12.3 minutes, P < .001). Logistic regression analysis confirmed that DNT was an independent predictor of PSCI (odds ratio = 1.125, 95% confidence interval: 1.071-1.182, P < .001). ROC curve analysis demonstrated that a DNT threshold of 52.5 minutes yielded a sensitivity of 89.0% and a specificity of 59.3% for predicting PSCI. Prolonged DNT is independently associated with an increased risk of PSCI within 6 months after stroke. Despite its high sensitivity, the predictive specificity of DNT remains limited, necessitating further studies incorporating additional risk factors to enhance predictive accuracy. These findings emphasize the importance of minimizing DNT delays in stroke management to improve long-term cognitive outcomes.