直接入院与转院患者大缺血性卒中的血管内治疗：一项二次分析
Endovascular therapy for large ischemic stroke in directly admitted versus transferred patients: A secondary analysis.
作者信息
Li Man, Zheng Lina, Nie Ximing, Wang Mengxing, Liu Xin, Duan Wanying, Zhang Zhe, Wen Miao, Yang Zhonghua, Huo Xiaochuan, Leng Xinyi, Pan Yuesong, Nguyen Thanh N, Miao Zhongrong, Liu Liping
机构信息
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
出版信息
Int J Stroke. 2025 Jul;20(6):731-740. doi: 10.1177/17474930251325085. Epub 2025 Feb 19.
BACKGROUND
Endovascular therapy (EVT) has been proved beneficial in patients with acute large vessel occlusion (LVO) with large infarcts, but it is unknown whether the benefit would be affected by the interhospital-transfer status. We investigated the efficacy of EVT according to the interhospital-transfer status in such patients.
METHODS
This was a secondary analysis of the ANGEL-ASPECT trial. Patients with acute anterior-circulation LVO and large infarcts, defined by Alberta stroke program early CT score (ASPECTS) 3-5 or infarct core volume 70-100 mL, were enrolled from 46 centers across China and randomized (1:1) to receive EVT with medical management (MM) versus MM alone. We dichotomized patients into two subgroups based on whether admitted directly to the EVT-capable center or transferred from a primary center. The primary outcome was the 90-day modified Rankin Scale (mRS).
RESULTS
From October 2020 to May 2022, 456 patients were recruited and one withdrew consent. So, 455 patients were included in this analysis, with 210 (46.2%) in the direct subgroup and 245 (53.8%) in the transfer subgroup. The transfer subgroup had longer median onset-to-arrival time than the direct patients (379 vs 279 mins, < 0.001), while there was no significant difference in the arrival-to-recanalization time (197 vs 205 mins, = 0.087) between the two subgroups. A significant ordinal shift of 90-day mRS toward a better functional outcome in EVT than MM (generalized odds ratio [gOR] = 1.67; 95% confidence interval (CI) = 1.03-2.70, = 0.036 versus gOR = 1.60; 95% CI = 1.02-2.50, = 0.039) was found in the direct and transfer group, respectively. There was no significant interaction of the two subgroups over the treatment effect of EVT versus MM on the primary outcome ( for interaction = 0.706).
CONCLUSIONS
In acute anterior-circulation LVO patients with large infarcts, the benefit of EVT compared to MM did not vary by the interhospital-transfer status.
背景
血管内治疗（EVT）已被证明对急性大血管闭塞（LVO）且梗死面积大的患者有益，但这种益处是否会受到院间转运状态的影响尚不清楚。我们研究了此类患者中根据院间转运状态进行EVT的疗效。
方法
这是对ANGEL-ASPECT试验的二次分析。纳入来自中国46个中心的急性前循环LVO且梗死面积大的患者，这些患者由阿尔伯塔卒中项目早期CT评分（ASPECTS）3-5或梗死核心体积70-100 mL定义，并随机（1:1）接受EVT联合药物治疗（MM）或单纯MM治疗。根据患者是直接入住具备EVT能力的中心还是从基层中心转运，将患者分为两个亚组。主要结局是90天改良Rankin量表（mRS）。
结果
2020年10月至2022年5月，共招募456例患者，1例撤回同意书。因此，本分析纳入455例患者，直接亚组210例（46.2%），转运亚组245例（53.8%）。转运亚组从发病到到达的中位时间比直接入院患者长（379分钟对279分钟，<0.001），而两个亚组从到达至再通时间无显著差异（197分钟对205分钟，=0.087）。在直接组和转运组中，分别发现EVT组90天mRS向更好功能结局的显著有序转变优于MM组（广义优势比[gOR]=1.67；95%置信区间[CI]=1.03-2.70，=0.036对gOR=1.60；95%CI=1.02-2.50，=0.039）。在EVT与MM对主要结局的治疗效果上，两个亚组之间没有显著的交互作用（交互作用的=0.706）。
结论
在急性前循环LVO且梗死面积大的患者中，与MM相比，EVT的益处不会因院间转运状态而有所不同。
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