Heterogeneity in Time-Outcome Associations After Endovascular Thrombectomy: A Binational Registry Study.
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Lin Chun-Jen, Kim Yong Soo, Yang Chung-Han, Hsieh Yi-Chen, Park Jong-Moo, Chen Chih-Hao, Kang Kyusik, Shan Sung Pi-, Lee Soo Joo, Chen Yu-Wei, Cha Jae-Kwan, Lin Kuan-Hung, Park Tai Hwan, Tang Chih-Wei, Lee Kyungbok, Chu Hai-Jui, Lee Jun, Fu Chuan-Hsiu, Hong Keun-Sik, Chou Chao-Liang, Yu Kyung-Ho, Lin Ching-Huang, Kim Dong-Eog, Yen Shang-Yih, Kim Joon-Tae, Chen Po-Lin, Choi Jay Chol, Kwon Jee Hyun, Shin Dong-Ick, Sohn Sung-Il, Chiou Hung-Yi, Kim Chulho, Park Kwang-Yeol, Kim Chi Kyung, Lien Li-Ming, Heo Sung Hyuk, Lee Jiunn-Tay, Chan Lung, Tang Sung-Chun, Kim Beom Joon, Chung Chih-Ping, Jeng Jiann-Shing, Bae Hee-Joon, TREAT-AIS and CRCS-K investigators
Аннотация
METHODS: We analyzed data from two multicenter registries in Korea (CRCS-K) and Taiwan (TREAT-AIS) from January 2019 to April 2023. Patients with anterior circulation acute ischemic stroke due to cardioembolism (CE) or large artery atherosclerosis (LAA) were included. Multivariable regression and interaction analyses were performed to evaluate the association between onset-to-puncture (OTP) time and 90-day functional outcomes and to identify effect modifiers.
RESULTS: Among 4,719 patients (mean age 72.0 years; 42.9% women; median NIHSS 15), longer OTP time was associated with lower odds of 90-day functional independence (adjusted OR per hour, 0.97; 95% CI, 0.96-0.98; p=0.001). The impact of OTP time varied by stroke characteristics. CE etiology, MCA occlusion, higher NIHSS, and male sex were associated with greater time sensitivity. In CE strokes, each hour of delay reduced the odds of functional independence by 4% (aOR, 0.96; 95% CI, 0.94-0.97; p<0.001), whereas no significant association was observed in LAA strokes (P_interaction=0.028).
CONCLUSION: The association between EVT timing and functional outcome varies according to stroke etiology and clinical characteristics, highlighting heterogeneity in time-outcome relationships among EVT-treated patients and providing observational insight into outcome variability in extended treatment windows.