Workflow Intervals and Outcomes of Endovascular Treatment for Acute Large-Vessel Occlusion During On-Vs. Off-hours in China: The ANGEL-ACT Registry

Yunlong Ding; Feng Gao; Yong Ji; Tingting Zhai; Xu Tong; Baixue Jia; Jian Wu; Jiaqi Wu; Yanrong Zhang; Can Wei; Wenjuan Wang; Jue Zhou; Jiali Niu; Zhongrong Miao; Yan Liu

doi:10.3389/fneur.2021.771803

Workflow Intervals and Outcomes of Endovascular Treatment for Acute Large-Vessel Occlusion During On-Vs. Off-hours in China: The ANGEL-ACT Registry

Front Neurol. 2021 Dec 21:12:771803. doi: 10.3389/fneur.2021.771803. eCollection 2021.

Authors

Yunlong Ding^{1

2}, Feng Gao^{2

3}, Yong Ji^{2

3}, Tingting Zhai^{1

2}, Xu Tong⁴, Baixue Jia⁴, Jian Wu^{2

3

5}, Jiaqi Wu^{2

5}, Yanrong Zhang^{1

2}, Can Wei^{1

2}, Wenjuan Wang^{1

2}, Jue Zhou^{1

2}, Jiali Niu^{2

6}, Zhongrong Miao⁴, Yan Liu^{1

2}

Affiliations

¹ Department of Neurology, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.
² Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.
³ Hospital Office, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.
⁴ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁵ Department of Rehabilitation, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.
⁶ Department of Clinical Pharmacy, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.

Abstract

Background: There may be a delay in or a poor outcome of endovascular treatment (EVT) among acute ischemic stroke (AIS) patients with large-vessel occlusion (LVO) during off-hours. By using a prospective, nationwide registry, we compared the workflow intervals and radiological/clinical outcomes between patients with acute LVO treated with EVT presenting during off- and on-hours. Methods: We analyzed prospectively collected Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) data. Patients presenting during off-hours were defined as those presenting to the emergency department from Monday to Friday between 17:30 and 08:00, on weekends (from 17:30 on Friday to 08:00 on Monday), and on national holidays. We used logistic regression models with adjustment for potential confounders to determine independent associations between the time of presentation and outcomes. Results: Among 1,788 patients, 1,079 (60.3%) presented during off-hours. The median onset-to-door time and onset-to-reperfusion time were significantly longer during off-hours than during on-hours (165 vs. 125 min, P = 0.002 and 410 vs. 392 min, P = 0.027). The rates of successful reperfusion and symptomatic intracranial hemorrhage were similar in both groups. The adjusted odds ratio (OR) for the 90-day modified Rankin Scale score was 0.892 [95% confidence interval (CI), 0.748-1.064]. The adjusted OR for the occurrence of functional independence was 0.892 (95% CI, 0.724-1.098), and the adjusted OR for mortality was 1.214 (95% CI, 0.919-1.603). Conclusions: Off-hours presentation in the nationwide real-world registry was associated with a delay in the visit and reperfusion time of EVT in patients with AIS. However, this delay was not associated with worse functional outcomes or higher mortality rates. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939.

Keywords: acute ischemic stroke; endovascular treatment; large vessel occlusion; off-hours; on-hours.

Associated data

ClinicalTrials.gov/NCT03370939