Workflow Intervals and Outcomes of Endovascular Treatment for Acute Large-Vessel Occlusion During On-Vs. Off-hours in China: The ANGEL-ACT Registry

Yunlong Ding, Feng Gao, Yong Ji, Tingting Zhai, Xu Tong, Baixue Jia, Jian Wu, Jiaqi Wu, Yanrong Zhang, Can Wei, Wenjuan Wang, Jue Zhou, Jiali Niu, Zhongrong Miao, Yan Liu, Yunlong Ding, Feng Gao, Yong Ji, Tingting Zhai, Xu Tong, Baixue Jia, Jian Wu, Jiaqi Wu, Yanrong Zhang, Can Wei, Wenjuan Wang, Jue Zhou, Jiali Niu, Zhongrong Miao, Yan Liu

Abstract

Background: There may be a delay in or a poor outcome of endovascular treatment (EVT) among acute ischemic stroke (AIS) patients with large-vessel occlusion (LVO) during off-hours. By using a prospective, nationwide registry, we compared the workflow intervals and radiological/clinical outcomes between patients with acute LVO treated with EVT presenting during off- and on-hours. Methods: We analyzed prospectively collected Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) data. Patients presenting during off-hours were defined as those presenting to the emergency department from Monday to Friday between 17:30 and 08:00, on weekends (from 17:30 on Friday to 08:00 on Monday), and on national holidays. We used logistic regression models with adjustment for potential confounders to determine independent associations between the time of presentation and outcomes. Results: Among 1,788 patients, 1,079 (60.3%) presented during off-hours. The median onset-to-door time and onset-to-reperfusion time were significantly longer during off-hours than during on-hours (165 vs. 125 min, P = 0.002 and 410 vs. 392 min, P = 0.027). The rates of successful reperfusion and symptomatic intracranial hemorrhage were similar in both groups. The adjusted odds ratio (OR) for the 90-day modified Rankin Scale score was 0.892 [95% confidence interval (CI), 0.748-1.064]. The adjusted OR for the occurrence of functional independence was 0.892 (95% CI, 0.724-1.098), and the adjusted OR for mortality was 1.214 (95% CI, 0.919-1.603). Conclusions: Off-hours presentation in the nationwide real-world registry was associated with a delay in the visit and reperfusion time of EVT in patients with AIS. However, this delay was not associated with worse functional outcomes or higher mortality rates. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939.

Keywords: acute ischemic stroke; endovascular treatment; large vessel occlusion; off-hours; on-hours.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Ding, Gao, Ji, Zhai, Tong, Jia, Wu, Wu, Zhang, Wei, Wang, Zhou, Niu, Miao and Liu.

Figures

Figure 1
Figure 1
Distribution of modified Rankin Scale (mRS) scores at 90 days.

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