Impact of Direct Transport to Thrombectomy-Capable Center vs. Nearby/Distant Local Stroke Centers on Stroke Outcome in Patients Undergoing Thrombectomy: A Real-Life Study
Abstract
:1. Introduction
2. Methods
2.1. Patient Population
2.2. Outcome Parameters
2.3. Data Analysis
2.4. Ethical Issues
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Total (N = 300) | DT (N = 187) | NH (N = 55) | DH (N = 58) | p |
---|---|---|---|---|---|
Demographic data and comorbidities | |||||
Female, n (%) | 121 (40.3) | 77 (41.2) | 25 (45.5) | 19 (32.8) | 0.29 |
Age, median (IQR), years | 72 (19) | 72 (20) | 72 (20) | 70.5 (15) | 0.67 |
Previous mRS score ≤ 1, n (%) | 258 (86) | 158 (84.5) | 50 (90.9) | 50 (86.2) | 0.07 |
Smoker, n (%) | 62 (20.7) | 40 (21.4) | 11 (20) | 11 (18.9) | 0.95 |
Alcoholism, n (%) | 34 (11.3) | 21 (11.3) | 6 (10.9) | 7 (12.1) | 0.90 |
Drug abuse, n (%) | 5 (1.6) | 4 (2.1) | 0 (0) | 1 (1.5) | 0.56 |
Glycemia, median (IQR), mg/dL | 127 (52.5) | 127 (61) | 127 (61) | 126 (50) | 0.81 |
Hypertension, n (%) | 188 (62.6) | 118 (63.1) | 32 (58.2) | 38 (65.5) | 0.91 |
Dyslipidemia, n (%) | 130 (43.4) | 78 (41.7) | 21 (38.2) | 31 (53.4) | 0.25 |
Diabetes mellitus, n (%) | 86 (28.7) | 56 (29.9) | 15 (27.3) | 15 (25.9) | 0.84 |
Ischemic cardiopathy, n (%) | 45 (15) | 32 (17.1) | 4 (7.3) | 9 (15.5) | 0.24 |
Previous stroke, n (%) | 27 (9) | 17 (9.1) | 5 (9.1) | 5 (8.6) | 0.8 |
Previous atrial fibrillation, n (%) | 67 (22.3) | 43 (23) | 13 (23.6) | 11 (19) | 0.73 |
De novo atrial fibrillation *, n (%) | 81 (27) | 50 (26.7) | 8 (14.5) | 23 (35.4) | 0.03 |
Prior treatments | |||||
Statins, n (%) | 133 (44.3) | 77 (41.2) | 25 (45.5) | 31 (53.4) | 0.11 |
Antiplatelet agents, n (%) | 103 (34.3) | 69 (36.9) | 17 (30.9) | 17 (29.3) | 0.75 |
Anticoagulants, n (%) | 39 (13) | 25 (13.4) | 7 (12.7) | 7 (12.1) | 0.98 |
Underdosed vitamin K antagonist **, n (%) | 18 (6.3) | 10 (5.3) | 4 (25) | 4 (26.7) | 0.87 |
Vascular territory | |||||
Anterior circulation, n (%) | 264 (87.3) | 165 (88.2) | 48 (87.3) | 51 (87.9) | 0.88 |
Left side, n (%) | 145 (48.7) | 88 (47.1) | 25 (45.5) | 32 (55.2) | 0.48 |
NIHSS, median (IQR) | 17 (9) | 17 (9) | 17 (9) | 17 (8) | 0.67 |
ASPECTS, median (IQR) | 10 (2) | 10 (2) | 10 (2) | 10 (2) | 0.11 |
Awakening stroke, n (%) | 57 (19) | 35 | 13 (23.6) | 9 (15.5) | 0.49 |
Secondary transfer time(median, IQR) | 169 (98) | - | 149 (87.5) | 188 (79) | 0.003 |
Stroke etiology (TOAST) | |||||
Cardioembolic, n (%) | 163 (54.3) | 104 (55.6) | 26 (47.3) | 33 (56.9) | 0.83 |
Atherothrombotic, n (%) | 58 (19.3) | 37 (19.8) | 11 (20) | 10 (17.2) | 0.84 |
Other determined etiology, n (%) | 14 (4.7) | 11 (5.9) | 1 (1.8) | 2 (3.4) | 0.48 |
Undetermined etiology, n (%) | 57 (19) | 35 (18.7) | 11 (2) | 11 (19) | 0.84 |
Blood biomarkers | |||||
Platelet volume ≥ 9.6 fL n (%) | 100 (33.3) | 68 (36.4) | 19 (34.5) | 13 (22.4) | 0.20 |
NT-proBNP, median (IQR), pg/mL | 1154 (2275.3) | 1024 (2417) | 1024 (2417) | 1439 (1881) | 0.17 |
Variable | Total (N = 300) | DT (N = 187) | NH (N = 55) | DH (N = 58) | p |
---|---|---|---|---|---|
Procedure | |||||
IVT, n (%) | 176 (58.7) | 111 (59.4) | 28 (50.9) | 37 (63.8) | 0.43 |
Onset-to-needle time, median (IQR), min | 120 (168) | 120 (75) | 120 (74) | 130 (64) | 0.32 |
Door-to-needle time, median (IQR), min | 48 (35) | 43 (27) | 43 (27) | 60 (48) | <0.001 |
Onset-to-groin time, median (IQR), min | 250 (234) | 204 (197) | 204 (196) | 328 (151) | <0.001 |
Door-to-groin time, median (IQR), min | 87 (50) | 95 (45) | 95 (41) | 64 (65) | <0.001 |
MT duration, median (IQR), min | 32 (40) | 34 (45) | 35 (46) | 30 (36) | 0.77 |
Passes in MT ≤ 3, n (%) | 170 (56.7) | 99 (52.9) | 37 (67.3) | 34 (58.6) | 0.05 |
Stent implantation, n (%) | 45 (15) | 30 (16) | 9 (16.4) | 6 (10.3) | 0.59 |
TICI 2b-3, n (%) | 226 (75.3) | 144 (77) | 37 (67.3) | 45 (77.6) | 0.82 |
TICI 0, n (%) | 14 (4.7) | 9 (4.8) | 2 (3.6) | 3 (5.2) | 0.62 |
In-hospital complications | |||||
Hemorrhagic transformation *, n (%) | 49 (16.3) | 23 (12.3) | 13 (23.6) | 13 (22.4) | 0.04 |
Brain edema with midline deviation, n (%) | 67 (22.3) | 39 (20.9) | 14 (25.5) | 14 (24.1) | 0.63 |
Craniectomy, n (%) | 8 (2.7) | 4 (2.1) | 2 (3.6) | 2 (3.4) | 0.74 |
Renal insufficiency, n (%) | 37 (12.3) | 29 (15.5) | 5 (9.1) | 6 (10.3) | 0.39 |
Renal failure, n (%) | 40 (12.3) | 29 (15.5) | 5 (9.1) | 6 (10.3) | 0.39 |
Lower respiratory tract infection, n (%) | 68 (22.7) | 40 (21.4) | 15 (27.3) | 13 (22.4) | 0.52 |
Urinary tract infection, n (%) | 26 (8.7) | 13 (6.9) | 7 (12.7) | 6 (10.3) | 0.3 |
Outcomes | |||||
Early neurological improvement **, n (%) | 39 (13) | 25 (13.6) | 11 (20) | 3 (5.2) | 0.06 |
Excellent outcome (mRS score = 0–1), n (%) | 72 (24) | 54 (28.9) | 10 (18.2) | 8 (13.8) | 0.07 |
Favorable outcome (mRS score = 0–2), n (%) | 106 (35.3) | 78 (41.7) | 15 (27.3) | 13 (22.4) | 0.03 |
Death, n (%) | 63 (21) | 39 (20.9) | 10 (18.2) | 14 (24.1) | 0.71 |
Variable | Unadjusted Analysis | Adjusted Analysis † | ||
---|---|---|---|---|
OR (95% CI) | p | OR (95% CI) | p | |
Demographics and comorbidities | ||||
Age | 0.95 (0.93–0.97) | <0.001 | 0.95 (0.92–0.98) | 0.001 |
Previous mRS score ≤ 1 | 5.89 (1.73–20.06) | 0.005 | - | - |
Diabetes mellitus | 0.64 (0.37–1.103) | 0.108 | - | - |
Atrial fibrillation | 0.61 (0.33–1.108) | 0.104 | - | - |
Drug abuse | 6.59 (0.72–54.94) | 0.09 | - | - |
Prior treatments | ||||
Statins | 0.71 (0.46–1.17) | 0.18 | - | - |
Anticoagulants | 0.56 (0.26–1.21) | 0.14 | - | - |
Underdosed vitamin K antagonist * | 0.23 (0.041–1.28) | 0.093 | - | - |
Transfer model | ||||
Direct transfer | Reference | - | - | |
NH | 2.35 (1.17–4.72) | 0.016 | - | - |
DH | 1.37 (0.59–3.3) | 0.48 | 0.37 (0.14–0.97) | 0.04 |
NIHSS | 0.9 (0.86–0.94) | <0.001 | 0.91 (0.86–0.96) | 0.001 |
Secondary transfer time | 0.99 (0.99–1.001) | 0.19 | ||
Stroke etiology (TOAST) | ||||
Other determined etiology | 2.17 (0.73–6.45) | 0.16 | - | - |
Blood biomarkers | ||||
NT-proBNP | 1.00 (1.00–1.00) | 0.012 | - | - |
Procedure | ||||
IVT | 1.59 (0.97–2.64) | 0.068 | - | - |
Door-to-needle time | 1.001 (0.99–1.005) | 0.70 | - | - |
Onset-to-groin time | 0.99 (0.99–1.00) | 0.13 | - | - |
Door-to-groin time | 1.00 (0.99–1.003) | 0.86 | - | - |
MT duration | 0.99 (0.99–1.003) | 0.26 | - | - |
Passes in MT ≤ 3 | 2.87 (1.36–6.06) | 0.006 | 3.8 (1.5–9.6) | 0.004 |
TICI 2b-3 | 2.8 (1.28–6.19) | 0.01 | - | - |
In-hospital outcomes and complications | ||||
Early neurological improvement ** | 0.105 (0.031–0.35) | <0.001 | - | - |
Hemorrhagic transformation *** | 0.19 (0.077–0.46) | <0.001 | - | - |
Brain edema with midline deviation | 0.087 (0.33–0.23) | <0.001 | 0.13 (0.038–0.42) | 0.001 |
Craniectomy | 0.00 (0.00–0.00) | 0.99 | - | - |
Renal insufficiency | 0.53 (0.25–1.16) | 0.11 | - | - |
Lower respiratory tract infection | 0.11 (0.047–0.28) | <0.001 | 0.18 (0.06–0.55) | 0.002 |
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del Toro-Pérez, C.; Amaya-Pascasio, L.; Arjona-Padillo, A.; Martínez-Sánchez, P. Impact of Direct Transport to Thrombectomy-Capable Center vs. Nearby/Distant Local Stroke Centers on Stroke Outcome in Patients Undergoing Thrombectomy: A Real-Life Study. J. Pers. Med. 2024, 14, 395. https://doi.org/10.3390/jpm14040395
del Toro-Pérez C, Amaya-Pascasio L, Arjona-Padillo A, Martínez-Sánchez P. Impact of Direct Transport to Thrombectomy-Capable Center vs. Nearby/Distant Local Stroke Centers on Stroke Outcome in Patients Undergoing Thrombectomy: A Real-Life Study. Journal of Personalized Medicine. 2024; 14(4):395. https://doi.org/10.3390/jpm14040395
Chicago/Turabian Styledel Toro-Pérez, Cristina, Laura Amaya-Pascasio, Antonio Arjona-Padillo, and Patricia Martínez-Sánchez. 2024. "Impact of Direct Transport to Thrombectomy-Capable Center vs. Nearby/Distant Local Stroke Centers on Stroke Outcome in Patients Undergoing Thrombectomy: A Real-Life Study" Journal of Personalized Medicine 14, no. 4: 395. https://doi.org/10.3390/jpm14040395