Introduction: Shorter onset-to-arrival (OTA) time is critical for acute ischemic stroke (AIS) patients potentially eligible for disability-reducing treatment including intravenous tPA and endovascular thrombectomy.
Hypothesis: Patients with earlier arrival would be more likely to be discharged home and have lower 30-day and 1-year mortality.
Methods: Prospective study of all AIS patients presenting to the 60 of 70 Massachusetts hospitals participating in the Coverdell Registry from 2005-13, excluding patients without documented onset or arrival times. Logistic regression analyses identified predictors of discharge disposition, in-hospital, 30-day, and 1-year mortality, accounting for clustering by hospital.
Results: Among the 41,856 patients in the sample, 30-day mortality was 6.7% and 1-year mortality was 12.6%. Of the 17,664 patients from 2011-13 with confirmed discharge disposition, 43.1% were discharged home, 8.4% died in-hospital or were discharged to hospice. Predictors of discharge disposition and mortality are outlined in the Table. OTA within 3.5 hours was associated with discharge to home, but had no affect on in-hospital, 30-day, or 1-year mortality. This pattern persisted both with and without tPA administration included in the model. Patients treated with tPA were more likely to be discharged to home. tPA administration was associated with in-hospital mortality, but reduced 1-year mortality. 30-day and 1-year mortality improved over the 8 years in the study period.
Conclusions: Patients arriving within 3.5 hours are more likely to be discharged to home, and patients treated with tPA are more likely to be discharged to home and have lower 1-year mortality.