TY - JOUR
T1 - Workflows and Outcomes in Patients With Suspected Large Vessel Occlusion Stroke Triaged in Urban and Nonurban Areas
AU - for the RACECAT Trial Investigators
AU - Garcia-Tornel, Alvaro
AU - Millan, Monica
AU - Rubiera, Marta
AU - Bustamante, Alejandro
AU - Requena, Manuel
AU - Dorado, Laura
AU - Olivé-Gadea, Marta
AU - Jiménez, Xavier
AU - Soto, Angels
AU - Querol, Marisol
AU - Hernández-Pérez, Maria
AU - Gomis, Meritxell
AU - Cardona, Pere
AU - Urra, Xabier
AU - Purroy, Francesc
AU - Silva, Yolanda
AU - Ustrell, Xavier
AU - Esteve, Patricia
AU - Salvat-Plana, Mercè
AU - Gallofré, Miquel
AU - Molina, Carlos
AU - Dávalos, Antoni
AU - Jovin, Tudor
AU - Abilleira, Sonia
AU - Ribo, Marc
AU - Pérez De La Ossa, Natalia
AU - Jacobi, Marc Ribó
AU - Sanjuan, Estela
AU - Santana, Katherine
AU - Rodríguez, Noelia
AU - Pagola, Jorge
AU - Rodriguez-Luna, David
AU - Maisterra, Olga
AU - Santamarina, Estevo
AU - Muchada, Marian
AU - Juega, Jesús
AU - Boned, Sandra
AU - Franco, Antonio Palasi
AU - García -Tornel, Álvaro
AU - Deck, Matías
AU - Sala, Victoria
AU - Muñoz, Lucía
AU - Millán, Mónica
AU - López-Cancio, Elena
AU - Hernández-Pérez, María
AU - Ciurans, Jordi
AU - Samaniego, Daniela
AU - Canento, Tamara
AU - Martin, Lorena
AU - Planas, Anna
N1 - Funding Information:
RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion) was supported by Fundació Ictus Malaltia Vascular through an unrestricted grant from MEDTRONIC, by a grant from the Spanish Ministry of Health cofinanced by Fondo Europeo de Desarrollo Regional (Instituto de Salud Carlos III, Red Temática de Investigación Cooperativa RETICS-INVICTUS-PLUS [Redes Temáticas en Enfermedades Vasculares Cerebrales Plus] RD0016/0019/0020), and from the PERIS (Pla Estratègic de Recerca i Innovació en Salut) programme from the Catalan Health Government (project SLT008/18/0007).
Funding Information:
Dr Pérez de la Ossa receives grant from the Spanish Ministry of Health cofinanced by Fondo Europeo de Desarrollo Regional (Instituto de Salud Carlos III, Red Temática de Investigación Cooperativa RETICS-RICORS RD21/0006/0024), and from the PERIS programme from the Catalan Health Government (project SLT008/18/0007), and received grants and personal fees from Medtronic and Boheringer-Angels Initiative. Dr Millán receives grant from the Spanish Ministry of Health cofinanced by Fondo Europeo de Desarrollo Regional (Instituto de Salud Carlos III, Red Temática de Investigación Cooperativa RETICS-RICORS RD21/0006/0024). Dr Bustamante receives grant from the Spanish Ministry of Health cofinanced by Fondo Europeo de Desarrollo Regional (Instituto de Salud Carlos III, Red Temática de Investigación Cooperativa RETICS-RICORS RD21/0006/0024). Dr Dorado receives grant from the Spanish Ministry of Health cofinanced by Fondo Europeo de Desarrollo Regional (Instituto de Salud Carlos III, Red Temática de Investigación Cooperativa RETICS-RICORS RD21/0006/0024). Dr Purroy receives grant from the Spanish Ministry of Health cofinanced by Fondo Europeo de Desarrollo Regional (Instituto de Salud Carlos III, Red Temática de Investigación Cooperativa RETICS-RICORS RD0016/0019/0023). Dr Salvat-Plana receives CIBER (Centro de Investigación Biomédica en Red) Epidemiología y Salud Pública (CIBERESP). Dr Molina receives honoraria for participation in clinical trials, contribution to advisory boards, or oral presentations from AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Bristol-Myers-Squibb, Covidien, Cerevast, and Brainsgate. Dr Dávalos receives consultancy and advisory board fees from Medtronic Neurovascular (Steering Committee STAR); and an unrestricted grant for the REVASCAT trial (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset) from Medtronic. Dr Ribó receives advisor and shareholder in Anaconda Biomed and Methinks and received grants and personal fees from Medtronic, personal fees from Stryker, Cerenovus, Philips, and Apta Targets. Dr Pérez de la Ossa, Garcia-Tornel, and Ribo had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The other authors report no conflicts.
Publisher Copyright:
© 2022 American Heart Association, Inc.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background: We aim to compare the outcome of patients from urban areas, where the referral center is able to perform thrombectomy, with patients from nonurban areas enrolled in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion). Methods: Patients with suspected large vessel occlusion stroke, as evaluated by a Rapid Arterial Occlusion Evaluation score of ≥5, from urban catchment areas of thrombectomy-capable centers during RACECAT trial enrollment period were included in the Stroke Code Registry of Catalonia. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with an ischemic stroke. Secondary outcomes included mortality at 90 days, rate of thrombolysis and thrombectomy, time from onset to thrombolysis, and thrombectomy initiation. Propensity score matching was used to assemble a cohort of patients with similar characteristics. Results: The analysis included 1369 patients from nonurban areas and 2502 patients from urban areas. We matched 920 patients with an ischemic stroke from urban areas and nonurban areas based on their propensity scores. Patients with ischemic stroke from nonurban areas had higher degrees of disability at 90 days (median [interquartle range] modified Rankin Scale score, 3 [2-5] versus 3 [1-5], common odds ratio, 1.25 [95% CI, 1.06-1.48]); the observed average effect was only significant in patients with large vessel stroke (common odds ratio, 1.36 [95% CI, 1.08-1.65]). Mortality rate was similar between groups(odds ratio, 1.02 [95% CI, 0.81-1.28]). Patients from nonurban areas had higher odds of receiving thrombolysis (odds ratio, 1.36 [95% CI, 1.16-1.67]), lower odds of receiving thrombectomy(odds ratio, 0.61 [95% CI, 0.51-0.75]), and longer time from stroke onset to thrombolysis (mean difference 38 minutes [95% CI, 25-52]) and thrombectomy(mean difference 66 minutes [95% CI, 37-95]). Conclusions: In Catalonia, Spain, patients with large vessel occlusion stroke triaged in nonurban areas had worse neurological outcomes than patients from urban areas, where the referral center was able to perform thrombectomy. Interventions aimed at improving organizational practices and the development of thrombectomy capabilities in centers located in remote areas should be pursued.
AB - Background: We aim to compare the outcome of patients from urban areas, where the referral center is able to perform thrombectomy, with patients from nonurban areas enrolled in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion). Methods: Patients with suspected large vessel occlusion stroke, as evaluated by a Rapid Arterial Occlusion Evaluation score of ≥5, from urban catchment areas of thrombectomy-capable centers during RACECAT trial enrollment period were included in the Stroke Code Registry of Catalonia. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with an ischemic stroke. Secondary outcomes included mortality at 90 days, rate of thrombolysis and thrombectomy, time from onset to thrombolysis, and thrombectomy initiation. Propensity score matching was used to assemble a cohort of patients with similar characteristics. Results: The analysis included 1369 patients from nonurban areas and 2502 patients from urban areas. We matched 920 patients with an ischemic stroke from urban areas and nonurban areas based on their propensity scores. Patients with ischemic stroke from nonurban areas had higher degrees of disability at 90 days (median [interquartle range] modified Rankin Scale score, 3 [2-5] versus 3 [1-5], common odds ratio, 1.25 [95% CI, 1.06-1.48]); the observed average effect was only significant in patients with large vessel stroke (common odds ratio, 1.36 [95% CI, 1.08-1.65]). Mortality rate was similar between groups(odds ratio, 1.02 [95% CI, 0.81-1.28]). Patients from nonurban areas had higher odds of receiving thrombolysis (odds ratio, 1.36 [95% CI, 1.16-1.67]), lower odds of receiving thrombectomy(odds ratio, 0.61 [95% CI, 0.51-0.75]), and longer time from stroke onset to thrombolysis (mean difference 38 minutes [95% CI, 25-52]) and thrombectomy(mean difference 66 minutes [95% CI, 37-95]). Conclusions: In Catalonia, Spain, patients with large vessel occlusion stroke triaged in nonurban areas had worse neurological outcomes than patients from urban areas, where the referral center was able to perform thrombectomy. Interventions aimed at improving organizational practices and the development of thrombectomy capabilities in centers located in remote areas should be pursued.
KW - emergency medical services
KW - hospital
KW - ischemic stroke
KW - registry
KW - thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85142940974&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.122.040768
DO - 10.1161/STROKEAHA.122.040768
M3 - Article
C2 - 36259411
AN - SCOPUS:85142940974
SN - 0039-2499
VL - 53
SP - 3728
EP - 3740
JO - Stroke
JF - Stroke
IS - 12
ER -