Dr. Jonathan Cauchi and colleagues conducted a study to determine whether there were differences in door-to-needle (DTN) times based on race and ethnicity, even among acute ischemic stroke patients arriving within the tissue plasminogen activator (TPA) time window.
In acute ischemic stroke, administration of intravenous TPA improves long-term clinical outcomes, with better outcomes occurring with earlier administration.
Prior research has shown racial and gender differences in stroke care and outcomes. Notably, in patients who receive TPA, there is a higher rate of hemorrhagic complications in black and Asian patients, but TPA efficacy is not affected by race or ethnicity.
There are limited data on whether race or ethnicity affects DTN times.
Longer DTN time of 12 minutes for Hispanic patients
Overall, 209 of 1,557 ischemic stroke patients - drawn from a stroke database at Mount Sinai Beth Israel Hospital from 2010 to 2015 - received TPA. The cohort included nine patients with transient ischemic attacks and 21 patients with non-stroke diagnoses.
The average DTN time for the 209 TPA cases was 60.5 ± 27.5 minutes.
Race/ethnicity was divided into four groups: non-Hispanic white patients, non-Hispanic black patients, Hispanic patients, and patients from other racial/ethnic backgrounds.
Compared with non-Hispanic whites, Hispanic patients had an average longer DTN time of 12 minutes, P<0.021.
The results also showed that the longer DTN times were independent of age, gender, and stroke severity.
There was no significant difference in DTN times between non-Hispanic white patients and non-Hispanic black patients.
Dr. Cauchi said that the significantly prolonged DTN times for Hispanic ischemic stroke patients who received TPA compared with non-Hispanic white patients may be due to language barriers.