Impact of interhospital transfer vs. direct admission on acute ischemic stroke patients: A subset analysis of the COMPLETE registry.

Background

Efficacy of thrombectomy treatment in acute ischemic stroke large vessel occlusion (AIS-LVO) patients is time dependent. Direct admission to thrombectomy centers (vs. interhospital transfer) may reduce time to treatment and improve outcomes. In this subset analysis of the COMPLETE registry, we compared outcomes between direct to thrombectomy center (Direct) vs. transfer from another hospital to thrombectomy center (Transfer) in AIS-LVO patients treated with aspiration thrombectomy.

Methods

COMPLETE was a prospective, international registry that enrolled patients from July 2018 to October 2019, with a 90-day follow-up period that was completed in January 2020. Imaging findings and safety events were adjudicated by core lab and independent medical reviewers, respectively. Pre-defined primary endpoints included post-procedure angiographic revascularization (mTICI ≥2b), 90-day functional outcome (mRS 0-2), and 90-day all-cause mortality. Planned collections of procedural time metrics and outcomes were used in the present

Results

Of 650 patients enrolled, 343 were transfer [52.8% female; mean (SD) age, 68.2 (13.9) years], and 307 were direct [55.4% female; 68.5 (14.5) years] admit. Median onset-to-puncture time took longer in the transfer vs. direct cohort (5.65 vs. 3.18 h: 2.33 h difference, respectively;

Conclusions

In the COMPLETE registry, direct to thrombectomy center was associated with significantly shorter onset-to-puncture times, and higher rates of good clinical outcome across different geographies. Additional research should focus on AIS-LVO detection to facilitate direct routing of patients to appropriate treatment centers.

Clinical trial registration

https://clinicaltrials.gov (Unique identifier: NCT03464565).

Informations de copyright

Copyright © 2022 Hassan, Zaidat, Nanda, Atchie, Woodward, Doerfler, Tomasello and Fifi.

Déclaration de conflit d'intérêts

AH: Consultant/Speakers bureau: GE Healthcare, Genentech, Medtronic, Microvention, Penumbra, Stryker, Cerenovus, Viz.ai, Balt and Scientia. OZ: Grant/research support from Genentech, Medtronic Neurovascular, Stryker. Consultant for Codman, Medtronic Neurovascular, National Institutes of Health StrokeNet, Penumbra, Stryker. Honoraria from Codman, Medtronic Neurovascular, Penumbra, Stryker. Serves as an expert witness. Ownership interest in Galaxy Therapeutics, Inc. JF: Grant/research support: Microvention, Penumbra, Stryker. Consultant: Microvention, Stryker. Other financial or material support: Ownership interest: Imperative Care. AN, BA, and AD: None. KW: Consulting and fees from Covidien. AT: Proctor and consultant for Medtronic, Stryker, MicroVention, and Perflow.