Abstract Body: Background and Objectives: Transportation to comprehensive stroke centers (CSCs) from primary stroke centers (PSCs) is key to achieving fast reperfusion in endovascular treatment (EVT)-eligible patients. We aimed to evaluate outcomes and workflow times of patients treated PSCs vs CSCs and additional key metrics for those transported from PSCs to CSCs for EVT.
Methods: We performed a pre-specified analysis of the Alteplase compared to Tenecteplase (AcT) multicenter, randomized, controlled, trial in patients with acute ischemic stroke within 4.5 hours of onset. We compared baseline characteristics, workflow times, and clinical outcomes at 90 days between PSCs and CSCs. Mixed effects regression analyses were performed adjusting for age, sex, National Institute of Health Stroke Scale (NIHSS), location of intracranial occlusion, IVT drug and door-to-needle-time as fixed effects; and study site as a random effect.
Results: Of 1,577 patients enrolled in the trial, 99 (6.27%) were treated in PSCs while 1,478 (93.72%) were treated in CSCs. Patients in both groups had similar age (median 72 [64 - 82] vs 74 [63 - 83] years), proportion of females (42.42% vs 48.24%), baseline stroke severity (median NIHSS 9 [6 - 16] vs 10 [6 - 16.5]), presence of large vessel occlusion (24.24% vs 24.70%; p=0.919) and EVT utilization (24.24% vs 32.61%). Patients treated in PSCs had longer onset-to-needle (median, 139 [100 - 190] vs 128 [94 - 185] minutes) and door-to-needle times (median, 56.5 [42 - 70] vs 35 [27 - 47] minutes) compared to those treated at CSCs. For patients transferred from PSCs to CSCs, patients who received tenecteplase had shorter needle-to-puncture times than those who received alteplase (median, 35.5 [21 - 58] vs 52 [18 - 74] minutes, p<0.001). The proportion of patients achieving excellent functional outcome (mRS 0-1) at 90 days was higher at PSCs compared to CSCs (48.48% vs 35.01%, adjusted IRR, 1.42 [CI 95%, 1.04 - 1.95]).
Conclusions: Despite less efficient workflows for IVT administration and similarities in baseline characteristics, the proportion of patients receiving initial treatment in PSCs who had excellent functional outcomes was higher compared to CSCs. Among those who received tenecteplase prior to CSC transfer, more efficient time metrics were noted.