Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.
Department of Internal Medicine, Medical School of Southeast University, Nanjing, China.
Int J Stroke. 2022 Jul;17(6):669-680. doi: 10.1177/17474930211012545. Epub 2021 May 4.
There is an ongoing debate on the off-hour effect on endovascular treatment (EVT) for acute large vessel occlusion (LVO).
This meta-analysis aimed to compare time metrics and clinical outcomes of acute LVO patients who presented/were treated during off-hour with those during working hours.
Structured searches on the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted through 23 February 2021. The primary outcomes were onset to door (OTD), door to imaging, door to puncture (DTP), puncture to recanalization, procedural time, successful recanalization, symptomatic intracranial hemorrhage (SICH), mortality in hospital, good prognosis (90-day modified Rankin Scale (mRS) score 0-2), and 90-day mortality. The secondary outcomes were imaging to puncture (ITP), onset to puncture (OTP), onset to recanalization (OTR), door to recanalization (DTR) time, mRS 0-2 at discharge, and consecutive 90-day mRS score. The odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) of the outcomes were calculated using random-effect models. Heterogenicity and publication bias were analyzed. Subgroup and sensitivity analyses were conducted as appropriate. Nineteen studies published between 2014 and 2021 with a total of 14,185 patients were eligible for quantitative synthesis. Patients in the off-hour group were significantly younger than those in the on-hour group and with comparable stroke severity and intravenous thrombolysis rate. The off-hour group had longer OTD (WMD [95% CI], 12.83 [1.84-23.82] min), DTP (WMD [95% CI], 11.45 [5.93-16.97] min), ITP (WMD [95% CI], 10.39 [4.61-16.17] min), OTP (WMD [95% CI], 25.30 [13.11-37.50] min), OTR (WMD [95% CI], 25.16 [10.28-40.04] min), and DTR (WMD [95% CI], 18.02 [10.01-26.03] min) time. Significantly lower successful recanalization rate (OR [95% CI], 0.85 [0.76-0.95]; = 0.004; = 0%) was detected in the off-hour group. No significant difference was noted regarding SICH and prognosis. But a trend toward lower OR of good prognosis was witnessed in the off-hour group (OR [95% CI], 0.92 [0.84-1.01]; = 0.084; = 0%).
Patients who presented/were treated during off-hour were associated with excessive delays before the initiation of EVT, lower successful reperfusion rate, and a trend toward worse prognosis when compared with working hours. Optimizing the workflows of EVT during off-hour is needed.
急性大血管闭塞（LVO）患者在非工作时间接受血管内治疗（EVT）的非工作时间效应仍存在争议。
本荟萃分析旨在比较在非工作时间就诊/接受治疗的急性 LVO 患者与在工作时间就诊/接受治疗的患者的时间指标和临床结局。
通过 2021 年 2 月 23 日在 PubMed、Embase、Web of Science 和 Cochrane Library 数据库进行了结构化检索。主要结局为发病至到院（OTD）、到院至影像、到院至穿刺（DTP）、穿刺至再通、手术时间、再通成功、症状性颅内出血（SICH）、住院死亡率、良好预后（90 天改良 Rankin 量表（mRS）评分 0-2）和 90 天死亡率。次要结局为影像至穿刺（ITP）、发病至穿刺（OTP）、发病至再通（OTR）、到院至再通（DTR）时间、出院时 mRS 0-2 评分和连续 90 天 mRS 评分。使用随机效应模型计算结局的比值比（OR）和加权均数差值（WMD）及其 95%置信区间（CI）。分析了异质性和发表偏倚。根据需要进行了亚组和敏感性分析。19 项发表于 2014 年至 2021 年的研究共纳入 14185 例患者，符合定量综合条件。非工作时间组患者明显比工作时间组患者年轻，且具有相似的卒中严重程度和静脉溶栓率。非工作时间组的 OTD（WMD [95% CI]，12.83 [1.84-23.82] min）、DTP（WMD [95% CI]，11.45 [5.93-16.97] min）、ITP（WMD [95% CI]，10.39 [4.61-16.17] min）、OTP（WMD [95% CI]，25.30 [13.11-37.50] min）、OTR（WMD [95% CI]，25.16 [10.28-40.04] min）和 DTR（WMD [95% CI]，18.02 [10.01-26.03] min）时间更长。非工作时间组的再通成功率显著较低（OR [95% CI]，0.85 [0.76-0.95]； = 0.004； = 0%）。SICH 和预后无显著差异。但非工作时间组良好预后的 OR 有下降趋势（OR [95% CI]，0.92 [0.84-1.01]； = 0.084； = 0%）。
与工作时间相比，在非工作时间就诊/接受治疗的患者在开始 EVT 前存在明显的延迟，再通成功率较低，且预后较差。需要优化非工作时间 EVT 的工作流程。
