ABSTRACT NUMBER: ESOC2026A1751 TRENDS IN DOOR-TO-NEEDLE TIME FOLLOWING EXPANSION OF THROMBOLYSIS INDICATIONS IN ACUTE ISCHAEMIC STROKE

Abstract Background and aims Since 2021, the European Stroke Organisation (ESO) guidelines have expanded intravenous thrombolysis (IVT) eligibility, increasing decision complexity in acute ischaemic stroke (AIS). How this affects door-to-needle time (DNT) remains unclear. This study examines DNT trends and their association with patient outcomes in Switzerland before and after guideline implementation. Methods We included 14,861 AIS patients from the Swiss Stroke Registry who received IVT between 2014 and 2023. DNT dynamics were analysed across subgroups, and associations with 90-day disability and mortality were assessed using multivariate regression models confirmed with LASSO regression. Results Implementation of the 2021 ESO guidelines was not associated with any increase in DNT. DNT remained stable over the decade (median DNT 40 minutes (IQR 29–58) for the period before 2021 versus 39 minutes (IQR 29–57) in/after 2021, p=0.1966). In multivariate analysis, factors associated with prolonged DNT were female sex (multiplicative effect ratio on median DNT 1.04, p=0.007), preexisting disability (pre-stroke modified Ranking Scale (mRS) >1; ratio 1.05, p<0.001), and treatment with direct oral anticoagulants (ratio 1.49, p<0.001) or vitamin K antagonists (ratio 1.24, p<0.001). Higher NIHSS at admission (ratio 0.985, p<0.001) and presentation during office hours (ratio 0.883, p<0.001) were associated with shorter DNT (Figure). Prolonged DNT was independently associated with increased 90-day disability (mRS, beta 0.12, p<0.001) and mortality (odds ratio 1.19, p<0.001). Conclusions Despite the implementation of recent guidelines extending treatment windows for IVT, DNT did not prolong in Switzerland. Treatment with anticoagulants, presentation outside office hours, and female sex were independent factors prolonging DNT. Conflict of interest Lorena Yun-Ni Phan: nothing to disclose Figure 1 - belongs to Results