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

Hassan AE, Zaidat OO, Nanda A, Atchie B, Woodward K, Dörfler A, Tomasello A, Fifi JT, Complete Registry Investigators (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Frontiers in Neurology Frontiers Research Foundation / Frontiers Media

Book Volume: 13

DOI: 10.3389/fneur.2022.896165

Abstract

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 & GE;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 post-hoc analysis to compare outcomes between transfer and direct patient cohorts. 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; p < 0.001). There was no significant difference in successful revascularization rate, mTICI & GE;2b (88.3 and 87.3%), sICH at 24 h (3.8 and 3.9%), median length of hospital stay (7 and 6 days), and 90-day mortality (16.9 and 14.0%) between transfer vs. direct patients, respectively. However, achieving 90-day functional independence was less likely in transfer compared with direct patients (mRS 0-2 was 50.3 vs. 61.7%, p = 0.0056). 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.

Authors with CRIS profile

Arnd Dörfler Department of Neuroradiology

Involved external institutions

University of Texas Rio Grande Valley (UTRGV) US United States (USA) (US) Mercy Health US United States (USA) (US) SSM Health St. Clare Hospital US United States (USA) (US) Radiology Imaging Associates (RIA) US United States (USA) (US) Fort Sanders Regional Medical Center US United States (USA) (US) Vall d'Hebron University Hospital / Hospital Universitari Vall d'Hebron ES Spain (ES) Icahn School of Medicine at Mount Sinai US United States (USA) (US)

How to cite

APA:

Hassan, A.E., Zaidat, O.O., Nanda, A., Atchie, B., Woodward, K., Dörfler, A.,... Complete Registry Investigators, . (2022). Impact of interhospital transfer vs. direct admission on acute ischemic stroke patients: A subset analysis of the COMPLETE registry. Frontiers in Neurology, 13. https://dx.doi.org/10.3389/fneur.2022.896165

MLA:

Hassan, Ameer E., et al. "Impact of interhospital transfer vs. direct admission on acute ischemic stroke patients: A subset analysis of the COMPLETE registry." Frontiers in Neurology 13 (2022).

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