Does Symptom Onset to Primary Stroke Center Time Goals Affect Stroke Outcome?

Abstract

Treating acute ischemic stroke (AIS) within 4.5hours and door-to-needle time of less than 60minutes may optimize recovery. It is unknown if onset to Primary Stroke Center (PSC) time goals affect outcome. The purpose of this study was to examine effects of symptom onset to PSC time goals on outcome. Analysis included prospectively collected data from the University of California San Diego Specialized Program of Treatment Research in Acute Stroke. All AIS patients treated with intravenous recombinant tissue plasminogen activator were included if treated within 270minutes, and 90-day modified Rankin Scale (mRS) score was known. Primary outcome of the 90-day mRS was analyzed using multivariable logistic regression. Good outcome was defined as a 90-day mRS score of 0-2. Variables assessed were time from onset to arrival, stroke code, neurologic exam, imaging, laboratories, treatment decision, and treatment (by quartiles). Two hundred ninety-one patients were included (49.8% female, mean age 70.6±16.1, median National Institutes of Health Stroke Scale 10, SD=8.5). Good outcome occurred in 45% of patients. Significant baseline differences included HTN (P ≤ .001), A fib (P ≤ .001), prestroke mRS (P<.001), and Hispanic ethnicity (P=.011). Comparing good with poor outcome groups: mean onset to arrival was 70.6min versus 62.5min (P=.129) and mean onset to treatment was 140.1min versus 134.9min (P=.118). Controlling for prespecified covariates, no PSC time goals were significant predictors of the 90-day outcome. In our Comprehensive Stroke Center (CSC), onset to PSC time goals were not significant predictors of the 90-day outcome. Expedited care processes in CSC may compensate for differences in outcome. These results should be validated in a larger cohort and in PSCs versus CSCs.