Meretoja Atte, Keshtkaran Mahsa, Tatlisumak Turgut, Donnan Geoffrey A, Churilov Leonid
From The Florey Institute of Neuroscience and Mental Health (A.M., M.K., G.A.D., L.C.) and Department of Medicine at the Royal Melbourne Hospital (A.M.), University of Melbourne, Parkville, Australia; Department of Neurology (A.M., T.T.), Helsinki University Hospital, Finland; RMIT University (M.K., L.C.), Melbourne, Australia; Department of Clinical Neurosciences/Neurology (T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
Neurology. 2017 May 30;88(22):2123-2127. doi: 10.1212/WNL.0000000000003981. Epub 2017 Apr 28.
To quantify the patient lifetime benefits gained from reduced delays in endovascular therapy for acute ischemic stroke.
We used observational prospective data of consecutive stroke patients treated with IV thrombolysis in Helsinki (1998-2014; n = 2,474) to describe distributions of age, sex, stroke severity, onset-to-treatment times, and 3-month modified Rankin Scale (mRS) in routine clinical practice. We used treatment effects by time of endovascular therapy in large vessel occlusion over and above thrombolysis as reported by the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) study to model the shift in 3-month mRS distributions with reducing treatment delays. From the 3-month outcomes we derived patient-expected lifetimes and cumulative long-term disability with incremental treatment delay reductions.
Each minute saved in onset-to-treatment time granted on average 4.2 days of extra healthy life, with a 95% prediction interval 2.3-5.4. Women gained slightly more than men due to their longer life expectancies. Patients younger than 55 years with severe strokes of NIH Stroke Scale score above 10 gained more than a week per each minute saved. In the whole cohort, every 20 minutes decrease in treatment delays led to a gain of average equivalent of 3 months of disability-free life.
Small reductions in endovascular delays lead to marked health benefits over patients' lifetimes. Services need to be optimized to reduce delays to endovascular therapy.
量化急性缺血性卒中血管内治疗延迟减少所带来的患者终身获益。
我们使用了在赫尔辛基接受静脉溶栓治疗的连续卒中患者的前瞻性观察数据（1998 - 2014年；n = 2474）来描述常规临床实践中患者的年龄、性别、卒中严重程度、发病至治疗时间以及3个月改良Rankin量表（mRS）分布情况。我们利用荷兰急性缺血性卒中血管内治疗多中心随机临床试验（MR CLEAN）研究报告的血管内治疗时间对大血管闭塞患者超过溶栓治疗的治疗效果，来模拟随着治疗延迟减少3个月mRS分布的变化。从3个月的结局中，我们得出了随着治疗延迟逐步减少患者的预期寿命和累积长期残疾情况。
发病至治疗时间每节省1分钟，平均可多获得4.2天的健康生命，95%预测区间为2.3 - 5.4天。由于女性预期寿命较长，她们获得的益处略多于男性。美国国立卫生研究院卒中量表评分高于10分的55岁以下重症卒中患者，每节省1分钟可多获得超过1周的健康生命。在整个队列中，治疗延迟每减少20分钟，平均可多获得相当于3个月无残疾生活的益处。
血管内治疗延迟的小幅减少会给患者带来显著的终身健康益处。需要优化服务以减少血管内治疗的延迟。
