Effect of the Number of Neurointerventionalists on Off-Hour Endovascular Therapy for Acute Ischemic Stroke Within 12 Hours of Symptom Onset

on the behalf of CRCS-K Investigators

Research output: Contribution to journalArticle

Abstract

Background: Off-hour presentation can affect treatment delay and clinical outcomes in endovascular therapy (EVT) for acute ischemic stroke. We aimed to examine the treatment delays and clinical outcomes of EVT between on- and off-hour admission and to evaluate the effect of hospital procedure volume and the number of neurointerventionalists on off-hour EVT. Methods and Results: From a multicenter registry, we identified patients who were treated with EVT within 12 hours of symptom. Annual hospital procedure volume was divided as low (<30), medium (30–60), and high (>60). The effect of the number of neurointerventionalists and annual hospital procedure volume on clinical outcome was estimated by the generalized estimation equation. Of the 31 133 stroke patients, 1564 patients met the eligibility criteria (mean age: 69±12 years; median baseline National Institutes of Health stroke scale score, 15 [interquartile range, 10–19]). Of 1564 patients, 893 (57.1%) arrived during off-hour. The off-hour patients had greater median door-to-puncture time (110 versus 95 minutes; P<0.001) compared with on-hour patients. Despite the treatment delay, the functional outcome at 3 months did not differ between off- and on-hour (odds ratio with 95% CI for 3-month modified Rankin Scale 0–2, 0.99 [0.78–1.25]; P=0.90). The presence of three neurointerventionalists was significantly associated with favorable outcomes at 3 months during on- and off-hour (2.07 [1.53–2.81]; P<0.001). The association was not observed for annual hospital procedural volume and the functional outcomes. Conclusions: The number of neurointerventionalists was more crucial to effective around-the-clock EVT for acute stroke patients than hospital procedural volume.

Original languageEnglish
Article numbere011933
JournalJournal of the American Heart Association
Volume8
Issue number21
DOIs
Publication statusPublished - 2019 Nov 5

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Stroke
Therapeutics
National Institutes of Health (U.S.)
Punctures
Registries
Odds Ratio

Keywords

  • hospital performance
  • interventional neuroradiology
  • stroke
  • stroke care
  • thrombectomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of the Number of Neurointerventionalists on Off-Hour Endovascular Therapy for Acute Ischemic Stroke Within 12 Hours of Symptom Onset. / on the behalf of CRCS-K Investigators.

In: Journal of the American Heart Association, Vol. 8, No. 21, e011933, 05.11.2019.

Research output: Contribution to journalArticle

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title = "Effect of the Number of Neurointerventionalists on Off-Hour Endovascular Therapy for Acute Ischemic Stroke Within 12 Hours of Symptom Onset",
abstract = "Background: Off-hour presentation can affect treatment delay and clinical outcomes in endovascular therapy (EVT) for acute ischemic stroke. We aimed to examine the treatment delays and clinical outcomes of EVT between on- and off-hour admission and to evaluate the effect of hospital procedure volume and the number of neurointerventionalists on off-hour EVT. Methods and Results: From a multicenter registry, we identified patients who were treated with EVT within 12 hours of symptom. Annual hospital procedure volume was divided as low (<30), medium (30–60), and high (>60). The effect of the number of neurointerventionalists and annual hospital procedure volume on clinical outcome was estimated by the generalized estimation equation. Of the 31 133 stroke patients, 1564 patients met the eligibility criteria (mean age: 69±12 years; median baseline National Institutes of Health stroke scale score, 15 [interquartile range, 10–19]). Of 1564 patients, 893 (57.1{\%}) arrived during off-hour. The off-hour patients had greater median door-to-puncture time (110 versus 95 minutes; P<0.001) compared with on-hour patients. Despite the treatment delay, the functional outcome at 3 months did not differ between off- and on-hour (odds ratio with 95{\%} CI for 3-month modified Rankin Scale 0–2, 0.99 [0.78–1.25]; P=0.90). The presence of three neurointerventionalists was significantly associated with favorable outcomes at 3 months during on- and off-hour (2.07 [1.53–2.81]; P<0.001). The association was not observed for annual hospital procedural volume and the functional outcomes. Conclusions: The number of neurointerventionalists was more crucial to effective around-the-clock EVT for acute stroke patients than hospital procedural volume.",
keywords = "hospital performance, interventional neuroradiology, stroke, stroke care, thrombectomy",
author = "{on the behalf of CRCS-K Investigators} and Kim, {Joong Goo} and Choi, {Jay Chol} and Kim, {Duk Ju} and Bae, {Hee Joon} and Lee, {Soo Joo} and Park, {Jong Moo} and Park, {Tai Hwan} and Cho, {Yong Jin} and Lee, {Kyung Bok} and Jun Lee and Kim, {Dong Eog} and Cha, {Jae Kwan} and Kim, {Joon Tae} and Lee, {Byung Chul} and Han, {Moon Ku} and Kim, {Beom Joon} and Jihoon Kang and Kyusik Kang and Kim, {Jae Guk} and Kim, {Dae Hyun} and Park, {Sang Soon} and Park, {Moo Seok} and Hong, {Keun Sik} and Park, {Hong Kyun} and Oh, {Mi Sun} and Yu, {Kyung Ho} and Ryu, {Wi Sun} and Cho, {Ki Hyun} and Kangho Choi and Kim, {Wook Joo} and Kwon, {Jee Hyun} and Shin, {Dong Ick} and Yum, {Kyu Sun} and Sohn, {Sung Il} and Hong, {Jeong Ho} and Joonsang Yoo and Jang, {Min Uk} and Lee Sang-Hwa and Park, {Kwang Yeol} and Lee, {June Young} and Lee, {Ji Sung}",
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T1 - Effect of the Number of Neurointerventionalists on Off-Hour Endovascular Therapy for Acute Ischemic Stroke Within 12 Hours of Symptom Onset

AU - on the behalf of CRCS-K Investigators

AU - Kim, Joong Goo

AU - Choi, Jay Chol

AU - Kim, Duk Ju

AU - Bae, Hee Joon

AU - Lee, Soo Joo

AU - Park, Jong Moo

AU - Park, Tai Hwan

AU - Cho, Yong Jin

AU - Lee, Kyung Bok

AU - Lee, Jun

AU - Kim, Dong Eog

AU - Cha, Jae Kwan

AU - Kim, Joon Tae

AU - Lee, Byung Chul

AU - Han, Moon Ku

AU - Kim, Beom Joon

AU - Kang, Jihoon

AU - Kang, Kyusik

AU - Kim, Jae Guk

AU - Kim, Dae Hyun

AU - Park, Sang Soon

AU - Park, Moo Seok

AU - Hong, Keun Sik

AU - Park, Hong Kyun

AU - Oh, Mi Sun

AU - Yu, Kyung Ho

AU - Ryu, Wi Sun

AU - Cho, Ki Hyun

AU - Choi, Kangho

AU - Kim, Wook Joo

AU - Kwon, Jee Hyun

AU - Shin, Dong Ick

AU - Yum, Kyu Sun

AU - Sohn, Sung Il

AU - Hong, Jeong Ho

AU - Yoo, Joonsang

AU - Jang, Min Uk

AU - Sang-Hwa, Lee

AU - Park, Kwang Yeol

AU - Lee, June Young

AU - Lee, Ji Sung

PY - 2019/11/5

Y1 - 2019/11/5

N2 - Background: Off-hour presentation can affect treatment delay and clinical outcomes in endovascular therapy (EVT) for acute ischemic stroke. We aimed to examine the treatment delays and clinical outcomes of EVT between on- and off-hour admission and to evaluate the effect of hospital procedure volume and the number of neurointerventionalists on off-hour EVT. Methods and Results: From a multicenter registry, we identified patients who were treated with EVT within 12 hours of symptom. Annual hospital procedure volume was divided as low (<30), medium (30–60), and high (>60). The effect of the number of neurointerventionalists and annual hospital procedure volume on clinical outcome was estimated by the generalized estimation equation. Of the 31 133 stroke patients, 1564 patients met the eligibility criteria (mean age: 69±12 years; median baseline National Institutes of Health stroke scale score, 15 [interquartile range, 10–19]). Of 1564 patients, 893 (57.1%) arrived during off-hour. The off-hour patients had greater median door-to-puncture time (110 versus 95 minutes; P<0.001) compared with on-hour patients. Despite the treatment delay, the functional outcome at 3 months did not differ between off- and on-hour (odds ratio with 95% CI for 3-month modified Rankin Scale 0–2, 0.99 [0.78–1.25]; P=0.90). The presence of three neurointerventionalists was significantly associated with favorable outcomes at 3 months during on- and off-hour (2.07 [1.53–2.81]; P<0.001). The association was not observed for annual hospital procedural volume and the functional outcomes. Conclusions: The number of neurointerventionalists was more crucial to effective around-the-clock EVT for acute stroke patients than hospital procedural volume.

AB - Background: Off-hour presentation can affect treatment delay and clinical outcomes in endovascular therapy (EVT) for acute ischemic stroke. We aimed to examine the treatment delays and clinical outcomes of EVT between on- and off-hour admission and to evaluate the effect of hospital procedure volume and the number of neurointerventionalists on off-hour EVT. Methods and Results: From a multicenter registry, we identified patients who were treated with EVT within 12 hours of symptom. Annual hospital procedure volume was divided as low (<30), medium (30–60), and high (>60). The effect of the number of neurointerventionalists and annual hospital procedure volume on clinical outcome was estimated by the generalized estimation equation. Of the 31 133 stroke patients, 1564 patients met the eligibility criteria (mean age: 69±12 years; median baseline National Institutes of Health stroke scale score, 15 [interquartile range, 10–19]). Of 1564 patients, 893 (57.1%) arrived during off-hour. The off-hour patients had greater median door-to-puncture time (110 versus 95 minutes; P<0.001) compared with on-hour patients. Despite the treatment delay, the functional outcome at 3 months did not differ between off- and on-hour (odds ratio with 95% CI for 3-month modified Rankin Scale 0–2, 0.99 [0.78–1.25]; P=0.90). The presence of three neurointerventionalists was significantly associated with favorable outcomes at 3 months during on- and off-hour (2.07 [1.53–2.81]; P<0.001). The association was not observed for annual hospital procedural volume and the functional outcomes. Conclusions: The number of neurointerventionalists was more crucial to effective around-the-clock EVT for acute stroke patients than hospital procedural volume.

KW - hospital performance

KW - interventional neuroradiology

KW - stroke

KW - stroke care

KW - thrombectomy

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U2 - 10.1161/JAHA.119.011933

DO - 10.1161/JAHA.119.011933

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VL - 8

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

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