Association of door-in-door-out time with clinical outcomes in patients with acute large vessel occlusion stroke of anterior circulation after early endovascular therapy
10.3760/cma.j.cn113694-20230912-00150
- VernacularTitle:入院-转出时间与急性大血管闭塞性脑卒中患者早期血管内治疗临床预后的关系
- Author:
Kangfei WU
1
;
Chengzhou HUANG
;
Yapeng GUO
;
Junfeng XU
;
Yi SUN
;
Yachen JI
;
Hao WANG
;
Zhiming ZHOU
;
Xianjun HUANG
;
Qian YANG
Author Information
1. 皖南医学院弋矶山医院神经内科，芜湖 241001
- Keywords:
Stroke;
Arterial occlusive diseases;
Patient transfer;
Prognosis;
Endovascular treatment
- From:
Chinese Journal of Neurology
2023;56(12):1371-1380
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the association between door-in-door-out time (DIDO) and clinical outcome of patients with acute large vessel occlusion stroke (AIS-LVO) of anterior circulation after early endovascular therapy (EVT).Methods:The patients with AIS-LVO of anterior circulation who received EVT in the advanced stroke center of the Yijishan Hospital of Wannan Medical College from February 2019 to December 2021 were retrospectively analyzed. The baseline characteristics, time metrics and clinical outcomes were collected. DIDO was defined as the duration of time from arrival to referral at the primary stroke center, and the primary outcome was favorable clinical outcome, as evaluated by a modified Rankin Scale score of 0 to 2 at 3 months after EVT. Univariate and multivariate regression analysis was used to explore the relationship between DIDO and early endovascular treatment clinical outcomes in patients with AIS-LVO.Results:A total of 320 patients [aged (69.6±10.2) years] were enrolled. The baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program early CT score were 14 (11, 18) and 8 (7, 9). The DIDO time was 76 (50, 120) minutes. DIDO was not an independent correlation factor for clinical outcomes in patients with EVT in the overall population. However, in patients receiving early EVT (onset-to-reperfusion≤300 minutes), DIDO ( OR=1.030, 95% CI 1.001-1.059, P=0.041) was an independent correlating factor of clinical outcome in patients with EVT. According to the receiver operating characteristic curve, the DIDO cutoff of 74.5 minutes can be used as an important indicator of prehospital delay in referral to EVT for large vascular occlusion stroke. Door to computed tomography time ( OR=1.393, 95% CI 1.212-1.601, P<0.001) and computed tomography to transfer time ( OR=1.386, 95% CI 1.220-1.575, P<0.001) were factors associated with DIDO≤74.5 minutes in a multivariate analysis in this time frame. Conclusions:In transferred patients undergoing EVT early, DIDO has a signifificant impact on clinical outcome. DIDO can be used as an important quality control indicator to evaluate the referral process for patients with AIS-LVO.
