Time to Presentation Is Associated with Clinical Outcome in Hemispheric Stroke Patients Deemed Ineligible for Recanalization Therapy

Abstract

Background Delayed thrombolysis adversely impacts functional outcome after stroke. Therefore, great efforts are undertaken to reduce delay in patient presentation and initiate treatment as quickly as possible. However, little is known regarding the impact of time to presentation (TTP) on outcome in patients that are ineligible for acute stroke therapy. Thus, we sought to determine whether the TTP is associated with the 90-day outcome irrespective of eligibility for acute recanalization therapy. Methods We retrospectively analyzed 258 consecutive acute ischemic stroke patients evaluated between January 2013 and February 2014. Multivariable logistic regression was used to determine whether a greater TTP is independently associated with a poor 90-day outcome as defined as a modified Rankin scale (mRS) score of 3–6. Results In unadjusted analyses the TTP was inversely correlated with transfer from an acute facility (r=−.126, P=0.043), cardioembolic stroke etiology (r=−.146, P=0.019), and acute recanalization therapy (r=.−412, P<0.001). Conversely, a longer TTP correlated with a worse 90-day mRS (r=.127, P=0.045). After adjustment, the TTP (P=0.019), age (P<0.001), female sex (P=0.001), National Institute of Health Stroke Scale score (P<0.001), pre-admission mRS (P=0.001), atrial fibrillation (P<0.001), and infarct volume (P<0.001) were independently associated with a poor 90-day outcome. Importantly, a longer TTP (OR 1.016; 95%-CI 1.001 to 1.032; P=0.036) remained independently associated with the 90-day outcome when we restricted analyses to patients ineligible for acute intravenous and endovascular recanalization therapies. Conclusions Each hour delay in the TTP decreased chances for good outcome by approximately 2% independent of patient eligibility for acute recanalization therapies.

Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion Therapies

“…The delays before the patient was seen by the first physician or the emergency department and before hospitalization were not independently related to clinical outcome (18). Similarly to our findings, in 178 patients ineligible for IVT or MT, 3 month outcome was significantly associated with admission NIHSS, age, and pre-stroke mRS, and marginally significantly with time to presentation (19). Severe disability or death 1 month after stroke in patients ineligible for recanalization therapy was associated with age, AF, and pre-stroke disability, and longer than 4.5 h to presentation (20).…”