Abstract Body: Introduction:
The American Stroke Association goals for Target: Stroke – Phase III include achieving a door to device (DTD) of 90 minutes or less for direct arriving patients in at least 50% of patients who undergo endovascular thrombectomy (EVT) or acute ischemic stroke patients with large vessel occlusion (LVO). While it is generally held that faster reperfusion is associated with better patient outcomes, the magnitude of benefit in achieving the goal of DTD Methods:
This is a retrospective analysis of acute ischemic stroke (AIS) patients from a multi-state stroke registry between January 2016 through March 2024. Mixed effects logistic regression models were fit to obtain an odds ratio of favorable mRS ( 90 groups, adjusting for age, race, sex, last known well to arrival time, hypertension, chronic renal insufficiency, diabetes, dementia, and initial NIHSS score in the final model, and clustering by hospital site. The final models included 1,317 patients with available MRS data and 1,789 patients with available discharge disposition data respectively. We used a mixed effects linear regression model to examine the relationship between DTD group and length of stay, controlling for age, race, sex, last known well to arrival time, initial NIHSS, atrial fibrillation, and alcohol/drug abuse and clustering by hospital site. The final model included 1,790 patients with complete data.
Results: Overall the predicted probability of 90 day MRS 90. Compared to the DTD > 90 group, the DTD <= 90 group had significantly higher odds of a favorable 90-day MRS with an adjusted OR of 1.57 (p = 0.002, 95% CI = [1.17, 2.09]). No significant difference was found across DTD groups in the odds of discharge to home (adjusted OR = 1.10 , p = 0.40, 95% CI = [0.87, 1.38]) or on length of stay (beta = 0.0, p = 0.90, 95% CI = [-0.9, 0.9]).
Conclusions:
Direct arriving AIS patients who receive EVT with a DTD