A Decade of Improvement in Door-to-Puncture Times for Mechanical Thrombectomy But Ongoing Stagnation in Prehospital Care

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00179906%3A_____%2F23%3A10468355" target="_blank" >RIV/00179906:_____/23:10468355 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216208:11150/23:10468355

Výsledek na webu

<a href="https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=OMo8BObgmZ" target="_blank" >https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=OMo8BObgmZ</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1161/SVIN.122.000561" target="_blank" >10.1161/SVIN.122.000561</a>

Jazyk výsledku

angličtina

Název v původním jazyce

A Decade of Improvement in Door-to-Puncture Times for Mechanical Thrombectomy But Ongoing Stagnation in Prehospital Care

Popis výsledku v původním jazyce

BACKGROUND: Systems of care surrounding endovascular therapy for stroke have garnered much attention in recent years. In hospital metrics, such as &quot;door-to-puncture&quot; and procedure times have been areas for quality improvement. The temporal trend and clinical significance of prehospital &quot;onset-to-door&quot; time, however, remains unknown. METHODS: We performed a systematic review of time metric data from all published randomized controlled and investigational device exemption trials involving endovascular therapy for stroke between 2005 and 2019 (n=26). Second, we conducted a record-level observational analysis on a total of 3512 patients from 3 real-world registries (Mechanical Embolus Removal in Cerebral Ischemia [MERCI], Thrombectomy REvascularization of Large Vessel Occlusions in Acute Ischemic Stroke [TREVO], and TREVO Stent-Retriever Acute Stroke [TRACK]), together with 4 prospective trials (MERCI trial, Multi-MERCI, TREVO-EU, and TREVO-2). Only patients receiving mechanical thrombectomy within 9 hours from onset-to-puncture time were included. Predictors of good outcome were identified using generalized linear mixed modeling. RESULTS: Door-to-puncture times (slope=-5.83 min/y; R 2=0.25; P=0.046), procedure times (slope=-3.78 min/y; R 2=0.54; P&lt;0.001), and onset-to-reperfusion times (slope=-11.82 min/y; R 2=0.57; P&lt;0.001) improved over the years among previously published randomized controlled trials/investigational device exemption trials from 2005 to 2019. The prehospital metric of onset-to-door time, however, remained statistically unchanged (slope=1.03 min/y; R 2&lt;0.01; P=0.806). Pooled analysis from record-level data demonstrated a similar temporal trend where door-to-puncture, procedure, and onset-to-reperfusion times declined by an average of 12 minutes (R 2=0.45; P&lt;0.0001), 6 minutes (R 2=0.27; P&lt;0.0001), and 8 minutes per year (R 2=0.18; P&lt;0.0001), respectively, over a similar time period. Time from onset to door, however, did not improve (3.6 min/y; R 2=0.34; P=0.005). In a backward-selection regression model, onset-to-door time was found to be a significant predictor of patient outcomes, where every hour delay in hospital arrival correlated with a 14% reduction in the odds of a good outcome. CONCLUSIONS: &quot;Door-to-puncture&quot; and procedure times have seen significant improvements over the past decade. The prehospital component of &quot;onset-to-door&quot; time, however, has remained stagnant. This presents an unrealized opportunity to enhance patient outcomes through improved systems of care in the prehospital setting.

Název v anglickém jazyce

A Decade of Improvement in Door-to-Puncture Times for Mechanical Thrombectomy But Ongoing Stagnation in Prehospital Care

Popis výsledku anglicky

BACKGROUND: Systems of care surrounding endovascular therapy for stroke have garnered much attention in recent years. In hospital metrics, such as &quot;door-to-puncture&quot; and procedure times have been areas for quality improvement. The temporal trend and clinical significance of prehospital &quot;onset-to-door&quot; time, however, remains unknown. METHODS: We performed a systematic review of time metric data from all published randomized controlled and investigational device exemption trials involving endovascular therapy for stroke between 2005 and 2019 (n=26). Second, we conducted a record-level observational analysis on a total of 3512 patients from 3 real-world registries (Mechanical Embolus Removal in Cerebral Ischemia [MERCI], Thrombectomy REvascularization of Large Vessel Occlusions in Acute Ischemic Stroke [TREVO], and TREVO Stent-Retriever Acute Stroke [TRACK]), together with 4 prospective trials (MERCI trial, Multi-MERCI, TREVO-EU, and TREVO-2). Only patients receiving mechanical thrombectomy within 9 hours from onset-to-puncture time were included. Predictors of good outcome were identified using generalized linear mixed modeling. RESULTS: Door-to-puncture times (slope=-5.83 min/y; R 2=0.25; P=0.046), procedure times (slope=-3.78 min/y; R 2=0.54; P&lt;0.001), and onset-to-reperfusion times (slope=-11.82 min/y; R 2=0.57; P&lt;0.001) improved over the years among previously published randomized controlled trials/investigational device exemption trials from 2005 to 2019. The prehospital metric of onset-to-door time, however, remained statistically unchanged (slope=1.03 min/y; R 2&lt;0.01; P=0.806). Pooled analysis from record-level data demonstrated a similar temporal trend where door-to-puncture, procedure, and onset-to-reperfusion times declined by an average of 12 minutes (R 2=0.45; P&lt;0.0001), 6 minutes (R 2=0.27; P&lt;0.0001), and 8 minutes per year (R 2=0.18; P&lt;0.0001), respectively, over a similar time period. Time from onset to door, however, did not improve (3.6 min/y; R 2=0.34; P=0.005). In a backward-selection regression model, onset-to-door time was found to be a significant predictor of patient outcomes, where every hour delay in hospital arrival correlated with a 14% reduction in the odds of a good outcome. CONCLUSIONS: &quot;Door-to-puncture&quot; and procedure times have seen significant improvements over the past decade. The prehospital component of &quot;onset-to-door&quot; time, however, has remained stagnant. This presents an unrealized opportunity to enhance patient outcomes through improved systems of care in the prehospital setting.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30224 - Radiology, nuclear medicine and medical imaging

Projekt

—

Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2023

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Stroke: Vascular and Interventional Neurology

ISSN

2694-5746

e-ISSN

2694-5746

Svazek periodika

3

Číslo periodika v rámci svazku

1

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

11

Strana od-do

e000561

Kód UT WoS článku

001157345000006

EID výsledku v databázi Scopus

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