Third International Stroke Trial 3
IST-3 included 849 patients treated within 3 h, and so provided valuable additional data on the effects of early treatment. The IST-3 data reinforced the importance of early treatment, because the benefit of i.v. rt-PA was greatest in patients treated within 3 h from symptom onset; for those treated within 3 h, the proportions alive and independent were 30.6 vs. 22.7% in the control group, equivalent to 79 more alive and independent patients per 1000 treated. The meta-analysis by Wardlaw confirmed that the relative benefits of rt-PA within 3 h were similar in the rather different population recruited in IST-3 to that observed in previous trials in this time window. The totality of the evidence from RCTs suggested that the absolute benefit for patients of all ages treated within 3 h was an increase in the number alive and independent patients of 90 per 1000 treated. Some experts prefer to give the number of patients alive and with a modified Rankin Scale or OHS score of 1 ('very favorable' outcome), in which case the absolute benefit for treatment within 3 h was 87 per 1000.
The Need for Prompt Treatment
IST-3 included 849 patients treated within 3 h, and so provided valuable additional data on the effects of early treatment. The IST-3 data reinforced the importance of early treatment, because the benefit of i.v. rt-PA was greatest in patients treated within 3 h from symptom onset; for those treated within 3 h, the proportions alive and independent were 30.6 vs. 22.7% in the control group, equivalent to 79 more alive and independent patients per 1000 treated. The meta-analysis by Wardlaw confirmed that the relative benefits of rt-PA within 3 h were similar in the rather different population recruited in IST-3 to that observed in previous trials in this time window. The totality of the evidence from RCTs suggested that the absolute benefit for patients of all ages treated within 3 h was an increase in the number alive and independent patients of 90 per 1000 treated. Some experts prefer to give the number of patients alive and with a modified Rankin Scale or OHS score of 1 ('very favorable' outcome), in which case the absolute benefit for treatment within 3 h was 87 per 1000.