Direct Admission vs. Secondary Transfer to a Comprehensive Stroke Center for Thrombectomy Retrospective Analysis of a Regional Stroke Registry with 2797 Patients
Direct Admission vs. Secondary Transfer to a Comprehensive Stroke Center for Thrombectomy Retrospective Analysis of a Regional Stroke Registry with 2797 Patients
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DOI：
10.1007/s00062-019-00842-9
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发表时间：
2019-10-11
影响因子：
2.8
通讯作者：
Moehlenbruch, Markus A.
中科院分区：
文献类型：
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作者：
Seker, Fatih;Bonekamp, Susanne;Moehlenbruch, Markus A.
背景和目的本研究旨在比较直接入住综合卒中中心的患者（DA）和从原发性卒中中心继发转移的患者（ST）取栓后的短期临床结果。方法在前瞻性区域性卒中登记中，所有发病前改良Rankin量表（mRS）评分为0-2分的卒中患者在24x202f内入院；回顾性分析2014年至2017年脑卒中后H及取栓治疗。比较DA和ST患者的良好预后比例（出院mRS 0-2）、出院mRS中位数、mRS移位（病前mRS与出院mRS的差值）和症状性颅内出血的发生。结果2797例患者中，1051例（37.6%）临床预后良好。DA组（n & x202f;= 1657）良好预后比例较高（DA 42.2% vs. ST 30.9%, P & x202f;< 0.001），中位出院mRS （DA 3 vs. ST 4, P & x202f;< 0.001）和中位mRS移位（DA 3 vs. ST 4, P & x202f;< 0.001）较低。两组症状性颅内出血发生率相似（DA 9.3% vs ST 7.5%, P & x202f;= 0.101）。多因素分析显示，直接入院是临床预后良好的独立预测因子（调整优势比OR 1.32，置信区间CI 1.09-1.60, P & x202f = 0.004）。结论：这些结果证实了先前的研究，即在卒中患者行血栓切除术时，到综合卒中中心进行DA治疗比ST治疗效果更好。
Background and Purpose This study aimed at comparing short-term clinical outcome after thrombectomy in patients directly admitted (DA) to a comprehensive stroke center with patients secondarily transferred (ST) from a primary stroke center. Methods In a prospective regional stroke registry, all stroke patients with a premorbid modified Rankin scale (mRS) score 0-2 who were admitted within 24 & x202f;h after stroke onset and treated with thrombectomy between 2014 and 2017 were retrospectively analyzed. Patients with DA and ST were compared regarding the proportion of good outcome (discharge mRS 0-2), median discharge mRS, mRS shift (difference between premorbid mRS and mRS on discharge) and occurrence of symptomatic intracranial hemorrhage. Results Out of 2797 patients, 1051 (37.6%) achieved good clinical outcome. In the DA group (n & x202f;= 1657), proportion of good outcome was higher (DA 42.2% vs. ST 30.9%, P & x202f;< 0.001) and median discharge mRS (DA 3 vs. ST 4, P & x202f;< 0.001) and median mRS shift (DA 3 vs. ST 4, P & x202f;< 0.001) were lower. The rate of symptomatic intracranial hemorrhage was similar in both groups (DA 9.3% vs. ST 7.5%, P & x202f;= 0.101). Multivariate analysis revealed that direct admission was an independent predictor of good clinical outcome (adjusted odds ratio, OR 1.32, confidence interval, CI 1.09-1.60, P & x202f;= 0.004). Conclusion These results confirm prior studies stating that DA to a comprehensive stroke center leads to better outcome compared to ST in stroke patients undergoing thrombectomy.