Impact of interhospital transfer vs. direct admission on acute ischemic stroke patients: A subset analysis of the COMPLETE registry
| Autor: | Ameer E. Hassan, Osama O. Zaidat, Ashish Nanda, Benjamin Atchie, Keith Woodward, Arnd Doerfler, Alejandro Tomasello, Johanna T. Fifi |
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| Přispěvatelé: | Institut Català de la Salut, [Hassan AE] Valley Baptist Medical Center, Neuroscience Department, University of Texas Rio Grande Valley, Harlingen, TX, United States. [Zaidat OO] Endovascular Neurology and Neuroscience, Mercy Health St. Vincent Medical Center, Toledo, OH, United States. [Nanda A] SSM St. Clare Healthcare, Fenton, MO, United States. [Atchie B] RIA Neurovascular, Englewood, CO, United States. [Woodward K] Fort Sanders Regional Medical Center, Knoxville, TN, United States. [Doerfler A] Department of Neuroradiology, Universitätsklinikum Erlangen, Erlangen, Germany. [Tomasello A] Grup de Recerca en Neuroradiologia, Vall d'Hebron Hospital Universitari, Barcelona, Spain. [Fifi JT] Icahn School of Medicine at Mount Sinai, New York, NY, United States, Vall d'Hebron Barcelona Hospital Campus |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Isquèmia cerebral - Cirurgia
Therapeutics::Patient Care::Therapeutics::Patient Care::Hospitalization::Patient Transfer [ANALYTICAL DIAGNOSTIC AND THERAPEUTIC TECHNIQUES AND EQUIPMENT] Vasos sanguinis - Cirurgia Neurology Hospitals - Pacients intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos vasculares::trombectomía [TÉCNICAS Y EQUIPOS ANALÍTICOS DIAGNÓSTICOS Y TERAPÉUTICOS] Surgical Procedures Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Thrombectomy [ANALYTICAL DIAGNOSTIC AND THERAPEUTIC TECHNIQUES AND EQUIPMENT] ddc:610 Neurology (clinical) Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Brain Ischemia [DISEASES] terapéutica::asistencia al paciente::terapéutica::asistencia al paciente::hospitalización::traslado de pacientes [TÉCNICAS Y EQUIPOS ANALÍTICOS DIAGNÓSTICOS Y TERAPÉUTICOS] enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::isquemia cerebral [ENFERMEDADES] |
| Zdroj: | Scientia |
| Popis: | BackgroundEfficacy of thrombectomy treatment in acute ischemic stroke large vessel occlusion (AIS-LVO) patients is time dependent. Direct admission to thrombectomy centers (vs. interhospital transfer) may reduce time to treatment and improve outcomes. In this subset analysis of the COMPLETE registry, we compared outcomes between direct to thrombectomy center (Direct) vs. transfer from another hospital to thrombectomy center (Transfer) in AIS-LVO patients treated with aspiration thrombectomy.MethodsCOMPLETE was a prospective, international registry that enrolled patients from July 2018 to October 2019, with a 90-day follow-up period that was completed in January 2020. Imaging findings and safety events were adjudicated by core lab and independent medical reviewers, respectively. Pre-defined primary endpoints included post-procedure angiographic revascularization (mTICI ≥2b), 90-day functional outcome (mRS 0–2), and 90-day all-cause mortality. Planned collections of procedural time metrics and outcomes were used in the present post-hoc analysis to compare outcomes between transfer and direct patient cohorts.ResultsOf 650 patients enrolled, 343 were transfer [52.8% female; mean (SD) age, 68.2 (13.9) years], and 307 were direct [55.4% female; 68.5 (14.5) years] admit. Median onset-to-puncture time took longer in the transfer vs. direct cohort (5.65 vs. 3.18 h: 2.33 h difference, respectively; p < 0.001). There was no significant difference in successful revascularization rate, mTICI ≥2b (88.3 and 87.3%), sICH at 24 h (3.8 and 3.9%), median length of hospital stay (7 and 6 days), and 90-day mortality (16.9 and 14.0%) between transfer vs. direct patients, respectively. However, achieving 90-day functional independence was less likely in transfer compared with direct patients (mRS 0–2 was 50.3 vs. 61.7%, p = 0.0056).ConclusionsIn the COMPLETE registry, direct to thrombectomy center was associated with significantly shorter onset-to-puncture times, and higher rates of good clinical outcome across different geographies. Additional research should focus on AIS-LVO detection to facilitate direct routing of patients to appropriate treatment centers.Clinical trial registrationhttps://clinicaltrials.gov (Unique identifier: NCT03464565). |
| Databáze: | OpenAIRE |
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