Table 5.
Association of IVT-to-EVT Times with Outcomes in IVT+EVT Cohort
| Home-Time, Days, Median [Interquartile rang] | Unadjusted OR/HR (95% CI) | Adjusted OR/HR (95% CI) | Unadjusted OR/HR (95% CI) | Adjusted OR/HR (95% CI) | ||
|---|---|---|---|---|---|---|
| IVT-to-EVT ≤60 min | IVT-to-EVT >60 min | Ref: IVT-to-EVT ≤60 min | Per 30-min increment* | |||
|
| ||||||
| Door-to-needle ≤30 min | ||||||
| 90-day home-time=0 | 1.25 (0.94, 1.66) | 1.56 (1.12, 2.19) | 1.03 (0.92, 1.14) | 1.11 (0.98, 1.26) | ||
| 90-day home-time>0, per 1% increase | 61 [1–83] | 44 [0–79] | 0.87 (0.70, 1.09) | 0.77 (0.61, 0.97) | 0.97 (0.90, 1.05) | 0.91 (0.83, 1.00) |
| 1-year home-time=0 | 1.09 (0.78, 1.52) | 1.38 (0.94, 2.02) | 1.04 (0.92, 1.17) | 1.15 (0.99, 1.33) | ||
| 1-year home-time>0, per 1% increase | 306 [9–354] | 298 [7–352] | 1.01 (0.77, 1.34) | 0.83 (0.62, 1.10) | 1.03 (0.93, 1.14) | 0.95 (0.85, 1.06) |
| 1-year mortality | 0.89 (0.68, 1.17) | - | 0.98 (0.89, 1.09) | - | ||
| 1-year readmission† | 1.05 (0.85, 1.28) | - | 1.01 (0.95, 1.07) | - | ||
|
| ||||||
| Door-to-needle ≤45 min | ||||||
| 90-day home-time =0 | 1.09 (0.91, 1.32) | 1.22 (1.00, 1.51) | 1.04 (0.98, 1.11) | 1.09 (1.01, 1.17) | ||
| 90-day home-time>0, per 1% increase | 57 [0–81] | 41 [0–77] | 0.82 (0.72, 0.94) | 0.76 (0.67, 0.87) | 0.94 (0.90, 0.98) | 0.91 (0.87, 0.96) |
| 1-year home-time =0 | 1.00 (0.82, 1.23) | 1.12 (0.89, 1.41) | 1.00 (0.93, 1.08) | 1.04 (0.96, 1.13) | ||
| 1-year home-time> 0, per 1% increase | 299 [5–351] | 282 [5–350] | 0.90 (0.77, 1.05) | 0.78 (0.66, 0.93) | 0.97 (0.92, 1.03) | 0.93 (0.88, 0.99) |
| 1-year mortality | 1.04 (0.88, 1.23) | 1.20 (1.00, 1.45) | 1.00 (0.95, 1.06) | 1.06 (0.99, 1.12) | ||
| 1-year readmission† | 1.11 (0.98, 1.25) | 1.20 (1.05, 1.38) | 1.01 (0.98, 1.05) | 1.02 (0.97, 1.07) | ||
|
| ||||||
| Door-to-needle ≤60 min | ||||||
| 90-day home-time=0 | 1.13 (0.97, 1.32) | 1.20 (1.01, 1.43) | 1.05 (0.99, 1.10) | 1.07 (1.01, 1.13) | ||
| 90-day home-time>0, per 1% increase | 54 [0–80] | 34 [0–76] | 0.80 (0.71, 0.90) | 0.75 (0.67, 0.84) | 0.93 (0.89, 0.97) | 0.91 (0.87, 0.94) |
| 1-year home-time=0 | 1.06 (0.89, 1.26) | 1.14 (0.94, 1.39) | 1.02 (0.97, 1.08) | 1.05 (0.99, 1.12) | ||
| 1-year home-time>0, per 1% increase | 286 [4–350] | 273 [4–348] | 0.89 (0.78, 1.02) | 0.81 (0.70, 0.94) | 0.97 (0.93, 1.01) | 0.94 (0.90, 0.99) |
| 1-year mortality | 1.07 (0.93, 1.23) | 1.16 (1.00, 1.35) | 1.01 (0.97, 1.06) | 1.05 (1.00, 1.10) | ||
| 1-year readmission† | 1.06 (0.96, 1.18) | 1.13 (1.01, 1.27) | 1.01 (0.98, 1.04) | 1.01 (0.97, 1.05) | ||
|
| ||||||
| Door-to-needle >60 min | ||||||
| 90-day home-time=0 | 1.34 (0.97, 1.84) | 1.65 (1.12, 2.44) | 1.14 (1.03, 1.27) | 1.24 (1.09, 1.40) | ||
| 90-day home-time>0, per 1% increase | 24 [0–71] | 10 [0–68] | 0.92 (0.71, 1.20) | 0.77 (0.59, 1.01) | 0.98 (0.89, 1.07) | 0.92 (0.84, 1.01) |
| 1-year home-time=0 | 1.15 (0.82, 1.63) | 0.72 (0.52, 1.00) | 1.07 (0.96, 1.19) | 1.17 (1.02, 1.34) | ||
| 1-year home-time> 0, per 1% increase | 215 [0–341] | 194 [0–337] | 1.00 (0.74, 1.36) | 1.52 (0.99, 2.34) | 0.99 (0.89, 1.10) | 0.89 (0.79, 0.99) |
| 1-year mortality | 0.98 (0.74, 1.31) | - | 0.99 (0.90, 1.08) | - | ||
| 1-year readmission† | 1.06 (0.81, 1.39) | - | 1.00 (0.93, 1.07) | - | ||
Data are expressed as Median [interquartile range], adjusted odds ratio (95% CI) for home-time, or adjusted hazard ratio (95% CI) for mortality and readmission.
Abbreviations: IVT, intravenous thrombolytic therapy; EVT, endovascular thrombectomy.
IVT-to-EVT time was defined as the time from IVT bolus to arterial puncture for EVT.
Home-time= 0 refers to patients who either died or were unable to be discharged home due to severe disability.
Home-time> 0 refers to those ever discharged home. Median home-time were calculated among patients with HT>0.
The associations of IVT-to-EVT times with home-time were estimated using a two-stage model, producing two adjusted odds ratios (ORs) for each comparison. The ORs for “home-time=0” indicated the ORs for having zero home-time in the longer IVT-to-EVT group compared with the shorter IVT-to-EVT group; values higher than one indicated that longer IVT-to-EVT was associated with higher odds of zero home days, an unfavorable outcome. The ORs for “home-time>0, per 1% increase” indicated the ORs of a one percent (of 90 days or 365 days) increase in the proportion of time at home in the longer IVT-to-EVT group compared with the shorter IVT-to-EVT group among those who were discharged to home; values lower than one indicated that longer IVT-to-EVT was associated with lower odds of additional days spent at home, an unfavorable outcome.
Covariates for the adjusted models: (1) patient characteristics: age, sex, race-ethnicity, insurance, comorbidities (atrial fibrillation/flutter, previous stroke and transient ischemic attack, history of coronary artery disease/myocardial infarction, heart failure, carotid stenosis, diabetes mellitus, peripheral artery disease, hypertension, dyslipidemia, renal insufficiency, and smoking), antiplatelet or anticoagulant, onset-to-arrival times, door-to-needle times, admission systolic blood pressure, heart rate, glucose, and stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS); and (2) hospital characteristics: geographic region, urban/rural, total bed number, annual ischemic stroke volume, teaching status, and stroke center certification.
IVT-to-EVT time was modeled as continuous variable.
Cause-specific model was used for readmission to account for competing risk of death.
- Data were not available because there were too few events to fit the adjusted model.