ASA: Delays in Hospital Care After Arrival Worsen Stroke Outcomes
Continuous quality improvement should minimize delays in door-to-puncture and door-to-reperfusion time
TUESDAY, March 16, 2021 (HealthDay News) -- Postarrival care delays are strongly associated with worse endovascular thrombectomy (EVT) patient outcomes in the early postarrival time period, according to research presented at the American Stroke Association International Stroke Conference, held virtually from March 17 to 19.
Mayank Goyal, M.D., Ph.D., from the University of Calgary in Alberta, Canada, and colleagues pooled patient-level data from participants in the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke trials. The analysis included early-treated patients (last known well [LKW]-to-puncture of four hours or less) from all seven randomized controlled trials of stent retriever thrombectomy devices (entirely or predominantly) versus medical therapy.
The researchers found that among the 781 EVT-treated patients overall, 406 (52.0 percent) were treated within four hours of LKW, with a median time of 188 minutes for LKW-to-door and 105 minutes for door-to-puncture. Substantial reperfusion was achieved among 295 of 372 individuals, and among them, door-to-reperfusion time was a median 145 minutes. Care process delays were more strongly associated with worse clinical outcomes in the door-to-puncture and door-to-reperfusion periods than for the LKW-to-door timeframe. For each 10-minute delay in door-to-puncture time versus LKW-to-door time, the amount of healthy life-years lost was 1.8 versus 0.0 months, respectively (P < 0.0001). Each 1-second delay in door-to-puncture time and door-to-reperfusion time was associated with 2.2 hours and 2.1 hours of healthy life-years lost, respectively.
"Fast, urgent delivery of stroke care is crucial for all stroke patients in order to reduce the risk of death and serious disability," a coauthor said in a statement.