Abstract 130: Impact of Time to Reperfusion in Endovascular Stroke Therapy on Outcome over the Entire Range of Disability
BACKGROUND: Faster time from onset to recanalization (TTR) in acute ischemic stroke using endovascular therapy (ET) has been associated with better outcome. However, prior studies have analyzed only dichotomized disability outcomes, which may underestimate the full effect of treatment.
METHODS: In the combined databases of the SWIFT and STAR trials, we identified patients treated with the Solitaire FR stent retriever with achievement of substantial reperfusion (TICI 2b-3). A multivariate linear regression model was used to assess factors associated with TTR.
RESULTS: Among 195 patients treated with ET with TICI2b-3 reperfusion, average age was 68, 62% were female, NIHSS was 16, and premorbid mRS was 0 in 71% and 1 in 16%. Target occlusion location was ICA in 14% and M1 in 71%, and 56% received IV tPA. Median TTR was 304 min (IQR 198-436). Shorter TTR was associated with improved median 90-day mRS (1.4 vs. 2.3 vs. 3.3, for TTR groups of 124-240 vs. 241-360 vs. 361-648, p<0.001). Increased NIHSS was associated with increased likelihood of longer TTR (18 min delay per 5 point increase in NIHSS, p<0.05). Adjusted 90 days mRS outcomes for TTR time intervals ranging from 180 to 480 minutes showed reductions in disability across the entire outcome range (Figure). The number of patients identified as benefitting from therapy with shorter TTR were 3-fold (range 1.6-5.1) higher on ordinal compared with dichotomized analysis. For every 15 minute acceleration of TTR, 31 per 1000 treated patients had improvement in outcome by at least one mRS health state.
CONCLUSIONS: Analysis of disability over the entire outcome range demonstrates a marked effect of shorter time to reperfusion upon improved clinical outcome, substantially higher than simple binary metrics. These findings emphasize the importance of accelerating endovascular reperfusion therapy.
Author Disclosures: S. Sheth: None. R. Jahan: None. J. Gralla: None. V.M. Pereira: None. R. Nogueira: None. O. Zaidat: None. J.L. Saver: None.
- © 2015 by American Heart Association, Inc.