Abstract 2: Good Outcome After Successful Recanalization is Time Dependent in the Swift Prime Randomized Controlled Trial
Background and Purpose: The SWIFT PRIME trial demonstrated superior outcomes in patients presenting with disabling acute ischemic stroke (AIS) who underwent endovascular therapy vs. intravenous tissue plasminogen activator (t-PA) alone. We sought to understand the relationship between functional independence and time to reperfusion in study patients assigned to thombectomy.
Methods: SWIFT PRIME is a global, multi-center, prospective, randomized, open, blinded endpoint study comparing functional outcomes in AIS subjects treated with either IV t-PA alone or IV t-PA in combination with Solitaire stent retriever device. Among patients in whom substantial reperfusion (TICI 2b/3) was achieved, we analyzed the effect onindependent outcome (mRS 0-2) of time from stroke onset to reperfusion (OTR) and from qualifying imaging to reperfusion
Results: Among 83 patients undergoing thrombectomy, substantial reperfusion was achieved in 73 (88%). A marked effect of OTR was noted (Figure 1A). The rate of functional independence was 87% if reperfusion was achieved 150 minutes from symptoms onset. The absolute rate of good outcomes decreased by 10% over the next 60 minutes of delay in OTR and by 15% with every 60 minute delay there-after. Faster post-arrival workflow speed improved outcomes among patients presenting directly to study hospitals (Figure 1B).
Conclusions: Speed of reperfusion is a dominant determinant of functional outcome among patients treated with stent retrievers. In the early period after, every 6 minute delay in reperfusion causes 1 more out of 100 treated patients to not achieve functional independence.
Author Disclosures: M. Goyal: Research Grant; Significant; Funding from Covidien for design and conduct of SWIFT PRIME trial. Part funding of ESCAPE trial from Covidien provided to Univ of Calgary. Speakers' Bureau; Significant; For teaching engagements from Covidien and Stryker. A.P. Jadhav: None. A. Bonafe: Consultant/Advisory Board; Modest; Covidien Neurovascular. H. Diener: Research Grant; Modest; Lundbeck, German Research Council (DFG), German Ministry of Education and Research (BMBF), European Union, NIH, Bertelsmann Foundation, Heinz-Nixdorf Foundation. Consultant/Advisory Board; Modest; Allergan, Abbott, Covidien Neurovascular, AstraZeneca, Bayer Vital, BMS, Boehringer Ingelheim, CoAxia, Corimmun, Daiichi-Sankyo, D-Pharm, Fresenius, GlaxoSmithKline, Janssen-Cilag, Johnson & Johnson, Knoll, Lilly, MSD, Medtronic, Mindframe, Neurobiological Technologies, Novartis, Novartis, Paion, Parke-Davis, Pfizer, Sanofi-Aventis, Schering-Plough, Servier, Solvay, Syngis, Talecris, Thrombogenics, WebMD Global, Wyeth, Yamanouchi. V. Pereira: Consultant/Advisory Board; Modest; Covidien Neurovascular. E. Levy: Expert Witness; Modest; Renders Medical/Legal Opinion. Ownership Interest; Modest; Intratech Medical Ltd., Blockade Medical LLC. Consultant/Advisory Board; Modest; Covidien Neurovascular. B. Baxter: Speakers' Bureau; Modest; Penumbra, Stryker, Covidien Neurovascular, Silk Road. T. Jovin: Consultant/Advisory Board; Modest; Air Liquide, Covidien Neurovascular, Silk Road Medical, Stryker Neurovascular. R. Jahan: Consultant/Advisory Board; Modest; Covidien Neurovascular. B. Menon: None. J. Saver: Consultant/Advisory Board; Modest; Covidien Neurovascular, Stryker.
- © 2016 by American Heart Association, Inc.