Association of Time of Day When Endovascular Therapy for Stroke Starts and Functional Outcome.

Details

Serval ID
serval:BIB_840213C8D029
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Association of Time of Day When Endovascular Therapy for Stroke Starts and Functional Outcome.
Journal
Neurology
Author(s)
Hajdu S.D., Kaesmacher J., Michel P.P., Sirimarco G., Knebel J.F., Bartolini B., Kurmann C.C., Puccinelli F., Mosimann P.J., Bonvin C., Arnold P.M., Niederhäuser J., Eskandari A., Mordasini P., Gralla P.J., Fischer P.U., Saliou P.G.
ISSN
1526-632X (Electronic)
ISSN-L
0028-3878
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
To investigate the association between EVT start time in acute ischemic stroke (AIS) and mid-term functional outcome.
This retrospective cohort study included all AIS cases treated with EVT from two stroke center registries from January 2012 to December 2018. The primary outcome was the score on the modified Rankin Scale (mRS) and the utility-weighted mRS (uw-mRS) at 90 days. A proportional odds model was used to calculate the common odds ratio as a measure of the likelihood that the intervention at a given EVT start time would lead to lower scores on the mRS (shift analysis).
One thousand five hundred fifty-eight cases were equally allotted into twelve EVT-start-time periods. The primary outcome favored EVT start times in the morning at 08:00-10:20 and 10:20-11:34 (common odds ratio (OR), 0.53; 95% confidence interval (CI), 0.38 to 0.75; P<0.001; OR, 0.62; 95% CI, 0.44 to 0.87; P=0.006, respectively), while it disfavored EVT start times at the end of the working day at 15:55-17:15 and 18:55-20:55 (OR, 1.47; 95% CI, 1.03 to 2.09; P=0.034; OR, 1.49; 95% CI, 1.03 to 2.15; P=0.033). Symptom onset-to-EVT start time was significantly higher and use of IV t-PA significantly lower between 10:20-11:34 (P<0.004 and P=0.012, respectively).
EVT for AIS in the morning leads to better mid-term functional outcome, while EVT at the end of the work day leads to poorer mid-term functional outcome. Neither difference in baseline factors, standard workflow and technical efficacy metrics could be identified as potential mediators of this effect.
Pubmed
Web of science
Open Access
Yes
Create date
11/01/2021 14:56
Last modification date
19/06/2021 6:33
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