Characteristics of Stroke Among Chinese in New York City (NYC)—Can we increase the use of tissue plasminogen activator (t-PA)?

 By Sun-Hoo Foo, M.D., Jing Fang, M.D. and Cora Fung

(printed in the July 2005 issue of CAMS Newsletter)

             While NYC Chinese has higher stroke mortality rate than whites, only a few cases had the benefit of using t-PA during the past years. To understand this, we recruited 136 consecutive Chinese stroke patients admitted to NYU Downtown Hospital (a community hospital located at NYC Chinatown). We interviewed the patients and reviewed the charts. Overall, 76.5% were ischemic stroke and the average age was 73.6 years. Forty nine patients (36%) came to the ER within 3 hours of symptom onset, 21 (16%) between 3-6 hours. Overall 70 (52.3%) came within 6 hours, 101 (77.6%) came within a day. After stroke attack, 36 patients (27%) went to Doctor’s office first, and 76 (55%) were at home, waiting for family member to get home and take them to ER. After registration in ER, 18 (13.4%) had Brain CT taken within 1 hour, 68 (50%) between 1-3 hours, 50 (37%) >3 hours.  Overall, 86 (63%) brain CT were completed within 3 hours. Presumed all those came to ER within 3 hours could have a brain CT within 1 hour and met the 3 hour deadline, at the current rate, less than 4.8% (37% x 13%) of the 136 Chinese stroke patients were eligible to use t-PA treatment. This explains the little use of t-PA in Chinese stroke patients in the past.

 If patients of the 4-6 hours range could be admitted within 3 hours, and have CT scan performed within 1 hour instead of 3, it would increase the number of eligible patient to at least 33% (52% x 63%) and would potentially increase t-PA usage. Patient’s education should include recognition of early symptoms; dial 911, to get to ER instead of waiting at home or going to doctors’ office.

 (Dr. Foo is Clinical Professor of Neurology at NYU medical School)