Abstract 147: Time to Angiographic Reperfusion Predicts Good Clinical Outcome in the Penumbra Studies
BACKGROUND: Faster time to reperfusion (TTR) is associated with better clinical outcome in the IMS trials and other cohorts. We tested this association in the Penumbra-sponsored studies of exclusively mechanical embolectomy cases.
METHODS: We pooled prospective (125 Pivotal, 289 PICS, 146 START) and retrospective/registry (157 POST, 225 RetroSTART) Penumbra cases. All were IV tPA-ineligible/refractory with treatment at <8 hours. Penumbral imaging selection was based on local practice. Pivotal and PICS revascularization results were core lab-adjudicated. Outcome assessments were not necessarily blinded. For this analysis, we included the subcohort achieving TICI 2-3 reperfusion of either ICA, M1, or M2 occlusions. We tested the association of TTR (based on time of procedure completion) and good clinical outcome (mRS 0-2 at 90 days) in both unadjusted and adjusted analyses. Tested covariates [age (per 10 years), gender, NIHSS strata (10-19 vs 20+), glucose, target vessel (MCA vs ICA), ASPECTS (0-4 vs 5-10)] with p<0.20 were considered in the multivariable model.
RESULTS: Among 942 subjects, 75 were excluded due to occlusion site and 186 due to missing key data (141 mRS, 75 TICI, 38 TTP). Reperfusion was achieved in 563 (83%) of 681 cases. Among these 563 cases, TTR was associated with mRS 0-2 (OR 0.95; 95% CI 0.91-1.00; p=0.045); see graph. In the final model with complete covariate data (n=347; 69 Pivotal, 0 POST, 133 PICS, 88 START, 57 Retro), TTR remained associated with mRS 0-2 (OR 0.92; 95% CI 0.86-0.98; p=0.01). Missing data did not appear to influence the results.
CONCLUSION: In this pooled cohort of Penumbra cases, TTR significantly predicted good clinical outcome. This is despite the possibility that registry data and local multimodal imaging selection methods could have favored inclusion of cases with better outcomes. Our findings suggest that rapid treatment should be emphasized regardless of the reperfusion and selection modality chosen.
Author Disclosures: P. Khatri: Honoraria; Modest; Academic Grand Rounds (paid to Dept). Other; Modest; Taylor and Francis-Stroke Ctr Handbook book royalties (paid to Dept). Research Grant; Significant; NIH/NINDS (IMS III, NSTN NCC/RCC). Other Research Support; Significant; Significant; Genentech-PRISMS Trial PI (paid to Dept), Penumbra-THERAPY Trial PI (paid to Dept). A. Yoo: Research Grant; Significant; NIH, Penumbra, Remedy. D. Frei: Ownership Interest; Modest; Penumbra. H. Buell: Employment; Significant; Penumbra. A. Bose: Employment; Significant; Penumbra. Ownership Interest; Significant; Penumbra. S. Sit: Employment; Significant; Penumbra. Ownership Interest; Significant; Penumbra.
- © 2014 by American Heart Association, Inc.