OBJECTIVE: To evaluate the safety and efficacy of intravenous recombinant tissue plasminogen activator (IV-rtPA) for acute ischaemic stroke through telemedicine consultation …published_or_final_versio

Chang, C

Chang, RSK

Cheung, RTF

Ho, SL

Hon, SFK

Kwan, WMM

Lee, JCY

Mak, W

Pang, SYY

Hong Kong Medical Journal

HKU Scholars Hub

Title First year of 24/7 Acute Stroke Unit. Part 2: outcome of strokethrombolysis using telemedicineAuthor(s) Chang, C; Hon, SFK; Kwan, WMM; Chang, RSK; Pang, SYY; Lee,JCY; Ho, SL; Cheung, RTF; Mak, WCitationThe 18th Medical Research Conference (MRC 2013), Departmentof Medicine, The University of Hong Kong, 12 January 2013. InHong Kong Medical Journal, 2013, v. 19 suppl. 1, p. 13, abstractno. 8Issued Date 2013URL http://hdl.handle.net/10722/190054Rights Hong Kong Medical Journal. Copyright © Hong Kong Academyof Medicine Press.Hong Kong Med J Vol 19 No 1 # Supplement 1 # February 2013      13PR prolongation strongly predicts new-onset myocardial infarction, ischaemic stroke, heart  failure, and cardiovascular death in coronary patients or risk equivalent: a 5-year clinical-pathophysiological studyYH Chan, KK Lau, KH Yiu, YF Yiu, SW Li, TH Lam, CP Lau, CW Siu, HF TseDivision of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong KongObjectives: To investigate the role of PR prolongation in new-onset adverse cardiovascular (CV) events in high-risk CV patients, and the underlying pathophysiological mechanisms in terms of vascular phenotypes.Methods: We prospectively followed up 597 high-risk CV out-patients (mean age 66±11 years; male 67%; coronary disease 55%, stroke 22%, diabetes 52%) for new-onset ischaemic stroke, myocardial infarction (MI), congestive heart failure (CHF), and CV death. Vascular phenotypes were assessed by high-resolution ultrasound for mean carotid intima-media thickness (IMT), and Vascular Profiling System (VP-2000; subgroup n=338) for pulse wave velocity (PWV). Impaired left ventricular ejection fraction (LVEF) from transthoracic echocardiography (subgroup, n=194) was defined as <35%. PR interval was determined from 12-lead electrocardiogram. Results: PR prolongation >200 ms was present in 79 (13%) patients at baseline, and was associated with a higher mean carotid IMT (1.05±0.37 mm vs 0.94±0.28 mm, P=0.010), higher PWV (1144±142 cm/s vs 1091±143 cm/s, P=0.024), and impaired LVEF of <35% (16% vs 5%, P=0.027). Adjusted for potential confounders, PR prolongation was independently associated with increased carotid IMT by +0.073 mm (95% confidence interval [CI]: 0.003-0.143, P=0.041). After a mean follow-up of 63±11 months, increased PR interval significantly predicted new-onset ischaemic stroke (P=0.006), CHF (P=0.040), CV death (P<0.001), and combined CV endpoints (P<0.001) at cut-off >200 ms, and new-onset MI at >162 ms (P=0.008) [C-statistic 0.70, P=0.001], with K-M analyses showing significantly reduced event-free survival (all P<0.05). Adjusting for potential confounders by multivariable cox regression, PR prolongation independently predicted increased risk of new-onset ischaemic stroke (hazard ratio [HR]=5.1, 95% CI: 1.3-19.1, P=0.017), CV death (HR=16.4, 95% CI: 4.0-67.5, P<0.001), combined CV endpoints (HR=2.3, 95% CI: 1.3-4.3, P=0.007) at cut-off >200 ms, and increased new-onset MI (HR=8.1, 95% CI: 1.7-39.1, P=0.010) at cut-off >162 ms. Conclusions: PR prolongation of >200 ms strongly predicts new-onset ischaemic stroke, MI, and CV death, and combined CV endpoint including CHF in high-risk CV patients. Increased risk of MI was observed at >162 ms. Abnormal vascular function may represent intermediate phenotypes or a mediating mechanism to clinical events.7First year of 24/7 Acute Stroke Unit. Part 2: Outcome of stroke thrombolysis using telemedicineC Chang, SFK Hon, MWM Kwan, RSK Chang, SYY Pang, JCY Lee, SL Ho, RTF Cheung, W MakDepartment of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong KongObjective: To evaluate the safety and efficacy of intravenous recombinant tissue plasminogen activator (IV-rtPA) for acute ischaemic stroke through telemedicine consultation.Methods: Records of stroke patients treated with IV-rtPA over the first 12 months of 24/7 thrombolytic service were reviewed. Outcomes of patients treated outside and during office hours, with the former through telemedicine consultation, were compared.Results: Of the 45 patients given IV-rtPA, 25 (55.6%) cases were treated during non-office hours and 20 (44.4%) cases during office hours by the on-site neurologists, with mean door-to-needle time of 102 minutes in the former and 98 minutes in the latter (P=0.64). The number of symptomatic intracranial haemorrhage and other complications in each group of patients was 3 or 4 (12% and 20%, P=0.68), respectively. Median modified-Rankin score (mRS) was 3 in patients treated during non-office hours with 28% achieving functional independence. There was no significant difference as compared to those treated during office hours (median mRS=3.5, P=0.3; proportion achieving functional independence=45%, P=0.35). The mortality rates in the two groups were 20% and 10% (P=0.44), respectively.Conclusion: Rapidity, safety, and outcome of IV-rtPA patients treated after office hours through telemedicine consultation are comparable to those managed during office hours by an on-site neurologist. Our data support that the current 24/7 IV-rtPA protocol is a feasible model for the effective administration of thrombolytic therapy to acute stroke patients.8

First year of 24/7 Acute Stroke Unit. Part 2: outcome of stroke thrombolysis using telemedicine

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First year of 24/7 Acute Stroke Unit. Part 2: outcome of stroke thrombolysis using telemedicine

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