Abstract TP24: Time from Symptoms Onset to Revascularization: Impact on Outcomes in Revascularized Swift Trial Patients
Introduction: Time from symptoms onset to revascularization (TOR) has been shown to be is an important predictor of clinical outcomes in mechanical thrombectomy for acute ischemic stroke (AIS). In this study, we sought to assess the influence of TOR on outcomes in the multicenter, randomized Solitaire FR with the Intention for Thrombectomy (SWIFT) trial.
Methods: AIS patients enrolled in the SWIFT trial who achieved the primary endpoint of successful recanalization without hemorrhage (SR-sICH) were included. The TOR was the main predictor variable. The main outcome variables were the 90 days modified Rankin’s Scale (mRS) ≤ 2; good neurologic outcome (Rankin’s Scale (mRS) ≤ 2 or NIHSS Improvement of ≥10), and mortality. P-values were calculated using Wilcoxon, linear regression, Cochran Mantel-Haenzsel, or Fischer exact tests.
Results: A total of 63 patients achieved SR-sICH and were included in this analysis. 57% patients had a good clinical outcome of mRS ≤ 2, with a mean TOR of 310(74) minutes vs. 348(80) minutes in those with mRS>2 at 90 days, p=0.08. Patients who died (19%) had a statistically longer TOR than survivors (TOR of 270(75) minutes versus 320(75) minutes in the survivors, p=0.04). Patients in lower quartiles had a trend toward improved neurological outcome and mortality (p=0.2 and p=0.1). When dichotomizing TOR to ≤6.5 hours (n=50) versus >6.5 hours (n=13), a trend toward better clinical outcome was noted in the ≤ 6.5 hours group; mRS ≤ 2 at 90-day (46% vs. 17%, p=0.008); with a trend toward improved good neurological outcome and mRS at 90 days (66% and 55% with p=0.19 and p=0.1, respectively) with no difference in mortality. A multivariate analysis model for predicting mRS at 90 days showed TOR as a significant predictor of neurological outcome (p=0.02).
Conclusions: A shorter time from TOR is associated with improved functional neurological outcome at 90 days in revascularized SWIFT trial patients.
- © 2012 by American Heart Association, Inc.