Mechanical thrombectomy (MT) performed during regular work hours is associated with a better functional outcome compared with MT performed after hours or on weekends or official holidays (“off-hours”), according to a study published in the Journal of Stroke and Cerebrovascular Diseases.
A multiorganizational team of US researchers collected data on patients who received MT at a comprehensive stroke center between 2014 and 2016. Primary outcomes for their analysis included discharge and 90-day modified Rankin Scale.
Propensity scores were developed for off-hours treatment, and investigators compared the 90-day functional outcome between on-hours (ie, work hours) vs off-hours. Independent variables included in the analysis were receiving thrombectomy during the off-hours, National Institute of Health Stroke Scale admission, door-to-groin time in minutes, age, and race.
The proportions of patients who underwent thrombectomy on-hours vs off-hours were 41% vs 59%, respectively. No differences were found between the 2 groups in terms of median admission National Institute of Health Stroke Scale, alteplase administration rates, mean time from last known well to thrombectomy, revascularization rate, and hemorrhagic transformation rate.
The probability of a favorable outcome at hospital discharge, as represented by an modified Rankin Scale of ≤2, was 12.6% lower among patients who received MT during off-hours (95% CI, −0.25 to −0.01; P =.038).
Among the 117 patients with a 90-day modified Rankin Scale, the favorable outcome probability was 18.7% lower for patients treated with MT during off-hours (95% CI, −0.36 to −0.02; P =.029).
The small sample size, as well as the inclusion of patients from 1 center, represent potential limitations of the analysis that may preclude generalizability of the findings.
“Strategies to improve [door to groin] time during off-hours could lead to improvement in the long-term functional outcome of patients receiving MT in the off-hours,” the researchers concluded.
Almallouhi E, Al Kasab S, Harvey JB, et al. Impact of treatment time on the long-term outcome of stroke patients treated with mechanical thrombectomy. J Stroke Cerebrovasc Dis. 2019;28(1):185-190.