血管内血栓切除术治疗时间与急性缺血性脑卒中后家庭出院时间的关系。
Association Between Time to Treatment With Endovascular Thrombectomy and Home-Time After Acute Ischemic Stroke.
机构信息
From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada.
出版信息
Neurology. 2024 Jun 25;102(12):e209454. doi: 10.1212/WNL.0000000000209454. Epub 2024 Jun 7.
BACKGROUND AND OBJECTIVES
Home-time is a patient-prioritized stroke outcome that can be derived from administrative data linkages. The effect of faster time-to-treatment with endovascular thrombectomy (EVT) on home-time after acute stroke is unknown.
METHODS
We used the Quality Improvement and Clinical Research registry to identify a cohort of patients who received EVT for acute ischemic stroke between 2015 and 2022 in Alberta, Canada. We calculated days at home in the first 90 days after stroke. We used ordinal regression across 6 ordered categories of home-time to evaluate the association between onset-to-arterial puncture and higher home-time, adjusting for age, sex, rural residence, NIH Stroke Scale, comorbidities, intravenous thrombolysis, and year of treatment. We used restricted cubic splines to assess the nonlinear relationship between continuous variation in time metrics and higher home-time, and also reported the adjusted odds ratios within time categories. We additionally evaluated door-to-puncture and reperfusion times. Finally, we analyzed home-time with zero-inflated models to determine the minutes of earlier treatment required to gain 1 day of home-time.
RESULTS
We had 1,885 individuals in our final analytic sample. There was a nonlinear increase in home-time with faster treatment when EVT was within 4 hours of stroke onset or 2 hours of hospital arrival. There was a higher odds of achieving more days at home when onset-to-puncture time was <2 hours (adjusted odds ratio 2.36, 95% CI 1.77-3.16) and 2 to <4 hours (1.37, 95% CI 1.11-1.71) compared with ≥6 hours, and when door-to-puncture time was <1 hour (aOR 2.25, 95% CI 1.74-2.90), 1 to <1.5 hours (aOR 1.89, 95% CI 1.47-2.41), and 1.5 to <2 hours (1.35, 95% CI 1.04-1.76) compared with ≥2 hours. Results were consistent for reperfusion times. For every hour of faster treatment within 6 hours of stroke onset, there was an estimated increase in home-time of 4.7 days, meaning that approximately 1 day of home-time was gained for each 12.8 minutes of faster treatment.
DISCUSSION
Faster time-to-treatment with EVT for acute stroke was associated with greater home-time, particularly within 4 hours of onset-to-puncture and 2 hours of door-to-puncture time. Within 6 hours of stroke onset, each 13 minutes of faster treatment is associated with a gain of 1 day of home-time.
背景与目的
家庭时间是一个以患者为中心的卒中结局，可以从行政数据链接中得出。血管内血栓切除术（EVT）治疗时间更快对急性卒中后家庭时间的影响尚不清楚。
方法
我们使用质量改进和临床研究登记处，在加拿大艾伯塔省确定了一个接受急性缺血性卒中 EVT 治疗的患者队列，时间为 2015 年至 2022 年。我们计算了卒中后 90 天内在家的天数。我们使用 6 个家庭时间有序类别的 ordinal 回归来评估从发病到动脉穿刺的时间与更高的家庭时间之间的关联，同时调整年龄、性别、农村居住、NIH 卒中量表、合并症、静脉溶栓和治疗年份。我们使用受限立方样条来评估时间指标的连续变化与更高家庭时间之间的非线性关系，并且还报告了时间类别内的调整后比值比。我们还评估了门到穿刺时间和再灌注时间。最后，我们使用零膨胀模型分析家庭时间，以确定获得 1 天家庭时间所需的治疗提前时间。
结果
我们最终的分析样本中有 1885 人。当 EVT 在卒中发病后 4 小时内或入院后 2 小时内进行时，治疗速度越快，家庭时间的增加就越呈非线性。与发病到穿刺时间≥6 小时相比，当发病到穿刺时间<2 小时（调整后的比值比 2.36，95%CI 1.77-3.16）和 2 至<4 小时（1.37，95%CI 1.11-1.71）时，达到更多家庭时间的几率更高，当门到穿刺时间<1 小时（aOR 2.25，95%CI 1.74-2.90）、1 至<1.5 小时（aOR 1.89，95%CI 1.47-2.41）和 1.5 至<2 小时（1.35，95%CI 1.04-1.76）时，达到更多家庭时间的几率更高。再灌注时间的结果也是一致的。在卒中发病后 6 小时内，每治疗 1 小时，家庭时间估计增加 4.7 天，这意味着治疗速度每加快 12.8 分钟，家庭时间就会增加 1 天。
讨论
急性卒中 EVT 治疗时间更快与更高的家庭时间相关，尤其是在发病到穿刺时间 4 小时内和门到穿刺时间 2 小时内。在卒中发病后 6 小时内，每治疗 13 分钟，家庭时间就会增加 1 天。
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