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

Bo Hu, Jiewei Hua Department of Neurology, The Fifth Hospital of Wuhan, Wuhan, Hubei, People’s Republic of ChinaCorrespondence: Bo Hu, Department of Neurology, The Fifth Hospital of Wuhan, No. 122 Xianzheng Street, Wuhan, Hubei, 430050, People’s Republic of China, Tel +86-19971987765, Email [email protected]: 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.Keywords: onset-to-needle time, acute ischemic stroke, intravenous thrombolysis, early neurological deterioration, influencing factors