Author + information
- Received February 25, 2020
- Revision received April 14, 2020
- Accepted May 12, 2020
- Published online September 21, 2020.
- Mohamad Alkhouli, MDa,∗ (, )
- Fahad Alqahtani, MDb,
- L. Nelson Hopkins, MDa,
- Alyssa H. Harris, MPHc,
- Samuel F. Hohmann, PhDc,d,
- Abdul Tarabishy, MDe and
- David R. Holmes, MDa
- aDepartment of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
- bDepartment of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- cCenter for Advanced Analytics and Informatics, Chicago, Illinois
- dDepartment of Health Systems Management, Rush University, Chicago, Illinois
- eDivision of Neuroradiology, West Virginia University, Morgantown, West Virginia
- ↵∗Address for correspondence:
Dr. Mohamad Alkhouli, Department of Cardiovascular, Mayo Clinic School of Medicine, 200 1st Street SW, Rochester, Minnesota 55905.
Objectives The aim of this study was to assess whether offering local endovascular stroke therapy (EST) rather than transferring patients off-site to receive EST would improve outcomes.
Background There are limited data to determine whether offering EST on-site rather than transferring patients to receive EST off-site improves clinical outcomes.
Methods A large academic consortium database was queried to identify patients with acute ischemic stroke who received EST between October 2015 and September 2019. Primary endpoints were in-hospital mortality and poor functional outcomes. Secondary endpoints were major complications, length of stay, and cost. Baseline characteristics were adjusted for using propensity score matching and multivariate risk adjustment.
Results A total of 22,193 patients with acute ischemic stroke who underwent EST (50.8% on-site, 49.2% off-site) were included. Mean ages were 67.9 ± 15.5 years and 68.4 ± 15.5 years, respectively (p = 0.03). In the propensity score matching analysis, mortality and poor functional outcomes were higher in the off-site EST group (14.7% vs. 11.2% and 40.7% vs. 35.9%, respectively; p < 0.001). In the risk-adjusted analyses with different models, in-hospital mortality and poor functional outcomes remained significantly higher in the off-site EST group. In the most comprehensive model (adjusting for age, sex, demographics, risk factors, tissue plasminogen activator use, and institutional EST volume), in-hospital mortality and poor functional outcomes were significantly higher in the off-site EST group, with odds ratios of 1.38 (95% confidence interval: 1.26 to 1.51) and 1.26 (95% confidence interval: 1.18 to 1.34), respectively (p < 0.001). The incidence of intracranial hemorrhage and mechanical ventilation was higher in the off-site group, but cost was higher in the on-site group in both the propensity score matching and risk-adjusted analyses.
Conclusions In contemporary U.S. practice, patients with acute ischemic stroke treated with EST on-site had lower in-hospital mortality and better functional outcomes compared with those transferred off-site for EST.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received February 25, 2020.
- Revision received April 14, 2020.
- Accepted May 12, 2020.
- 2020 American College of Cardiology Foundation
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