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

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

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.771803

DOI=10.3389/fneur.2021.771803

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> 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.</p><p><bold>Methods:</bold> 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.</p><p><bold>Results:</bold> 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, <italic>P</italic> = 0.002 and 410 vs. 392 min, <italic>P</italic> = 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).</p><p><bold>Conclusions:</bold> 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.</p><p><bold>Clinical Trial Registration:</bold> URL: <ext-link ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.clinicaltrials.gov</ext-link>; Unique identifier: NCT03370939.</p>