Endovascular Stroke Therapy More Beneficial On-Site Than Off-Site

Functional outcomes and in-hospital mortality were better in patients with acute ischemic stroke who received on-site endovascular stroke therapy (EST), compared with those who received therapy following transfer to another site, according to study results published in JACC: Cardiovascular Interventions.

EST has an important role in modern acute ischemic stroke care. However, limited data exist on results of EST after transferring patients to receive therapy off-site. The goal of this study was to compare the outcomes of on-site vs off-site EST for patients with acute ischemic stroke.

Researchers identified adults who underwent EST for acute ischemic stroke from the Vizient Clinical Database. The subjects were divided into 2 groups: on-site EST and off-site EST.

The primary outcomes were in-hospital mortality and poor functional outcomes, defined as death or discharge to hospice or a long-term nursing facility.

The study cohort included 22,193 patients who underwent EST for acute ischemic stroke at 99 centers, including 11,267 (50.8%; mean age, 67.9 years) who underwent therapy on-site and 10,926 (49.2%; mean age, 68.4 years) who were transferred to EST-capable centers.

Incidences of in-hospital mortality (13.7% vs 11.1%, respectfully; P <.001) and poor functional outcomes (38.6% vs 36.2%, respectfully; P <.001) were higher in the off-site EST group than those treated on-site. In addition, intracranial hemorrhage (20.6% vs 17.4%, respectfully; P <.001), and mechanical ventilation (33.1% vs 31.5%, respectfully; P =.01) were more frequent in the off-site EST group. In the on-site therapy group, patients were more likely to be discharged to home (24.6% vs 20.9%, respectively).

Using propensity-score matching, study researchers compared 2 pairs of 7557patients who had EST on- vs off-site. In this analysis, in-hospital mortality (14.7% vs 11.2%, respectfully; P <.001) and poor functional outcomes (40.7% vs 35.9%, respectfully; P <.001) remained significantly higher in the off-site EST group compared with the on-site group. The increased risk for in-hospital mortality and poor functional outcomes remained significant after study researchers applied several risk adjustment models.

The study had several limitations, including potential under- or over-coding of in-hospital procedures and complications; no information regarding outcomes beyond hospital discharge; and missing data on stroke severity, EST techniques, timing of intervention, transfer times and modes, and angiographic findings.

“In contemporary practice in the United States, AIS [acute ischemic stroke] patients who are treated with EST onsite achieved lower in-hospital mortality and better functional outcomes compared with those who are transferred to receive EST offsite,” concluded the study researchers.

Reference

Alkhouli M, Alqahtani F, Hopkins LN, et al. Clinical outcomes of on-Site versus off-Site endovascular stroke interventions. JACC: Cardiovascular Interventions. 2020;13(18):2159-2166. doi: 10.1016/j.jcin.2020.05.025