In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
Abstract:
Introduction: Interhospital transfer to endovascular-capable centers (ECCs) is reported to correlate with worse clinical outcome after endovascular stroke reperfusion therapy (ESRT). The aim of this study was to investigate the relationship between admission mode and functional outcome after ESRT in real clinical setting in Japan. Methods: The RICOVERY study retrospectively registered 575 patients with large vessel occlusion who were admitted to and underwent ESRT at 16 ECCs in Ibaraki prefecture, located just northeast of Tokyo, within 24 hours of onset between January 2015 and December 2017. We extracted patients without in-hospital stroke onset or recurrence and divided them into two groups: those with interhospital transfer (I group) and with direct admission to ECCs (D group). Favorable outcome (FO) was defined as a mRS of 0-2 at discharge. We additionally performed a subgroup analysis with patients with premorbid mRS of 0-2 and who underwent ESRT within 6 hours of onset. Results: A total of 483 patients (198 women, 75±11 years) was included. Intravenous thrombolysis was performed in 289 patients (60%). In the I group (n=69), median baseline NIHSS score was lower (17 vs 19, p=0.025) and the proportion of large-artery atherosclerosis was higher (19% vs 10%, p=0.025) compared with the D group (n=414). The rates of reperfusion (mTICI grade 2b/3) were similarly high in both groups (88% and 86%, respectively). Although median onset-to-puncture time (OPT) was longer in the I group than in the D group (240 min vs 185 min, p=0.01), no significant difference was shown in the rate of FO between the groups (28% vs 36%, p=0.197). In subgroup analysis, baseline NIHSS scores and stroke subtypes were similar between the I group (n=51) and the D group (n=273). Median OPT was longer in the I group than in the D group (220 min vs 160 min, p=0.005) as with the entire study cohort, and the rate of FO in the I group was lower than in the D group (24% vs 43%, p=0.01). After multivariate adjustment, interhospital transfer was a negative predictor of FO (Odds ratio, 0.343; 95% confidence interval, 0.158-0.747). Conclusion: In this Japanese real-world study, interhospital transfer was associated with delays of ESRT and lower chance of FO within a 6-hour time window.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.50.suppl_1.WMP11
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
1467823-8
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