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EXPRESS: Off-hour effect on time metrics and clinical outcomes in endovascular treatment for large vessel occlusion, a systematic review and meta-analysis
International Journal of Stroke ( IF 6.7 ) Pub Date : 2021-04-20 , DOI: 10.1177/17474930211012545
Mingming Zha 1 , Qingwen Yang 1 , Shuo Liu 2 , Min Wu 3 , Kangmo Huang 4 , Haodi Cai 1 , Xiaohao Zhang 4 , Qiushi Lv 4 , Rui Liu 4 , Dong Yang 4 , Xinfeng Liu 1, 3, 4
Affiliation  

Background

There is an ongoing debate on the off-hour effect on endovascular treatment (EVT) for acute large vessel occlusion (LVO).

Aims

This meta-analysis aimed to compare time metrics and clinical outcomes of acute LVO patients who presented/were treated during off-hour with those during working hours.

Summary of review

Structured searches on the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted through February 23rd, 2021. The primary outcomes were onset to door, door to imaging, door to puncture, puncture to recanalization, procedural time, successful recanalization, symptomatic intracerebral hemorrhage (SICH), mortality in hospital, good prognosis (90-day modified Rankin Scale [mRS] score 0-2), and 90-day mortality. The secondary outcomes were imaging to puncture, onset to puncture, onset to recanalization, door to recanalization time, mRS 0-2 at discharge, and consecutive 90-day mRS score. The odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) of the outcomes were calculated using random-effect models. Heterogenicity and publication bias were analyzed. Subgroup and sensitivity analyses were conducted as appropriate.

Nineteen studies published between 2014 and 2021 with a total of 14185 patients were eligible for quantitative synthesis. Patients in the off-hour group were significantly younger than those in the on-hour group and with comparable stroke severity and intravenous thrombolysis rate. The off-hour group had longer onset to door (WMD [95%CI], 12.83 [1.84-23.82] min), door to puncture (WMD [95%CI], 11.45 [5.93-16.97] min), imaging to puncture (WMD [95%CI], 10.39 [4.61-16.17] min), onset to puncture (WMD [95%CI], 25.30 [13.11-37.50] min), onset to recanalization (WMD [95%CI], 25.16 [10.28-40.04] min), and door to recanalization (WMD [95%CI], 18.02 [10.01-26.03] min) time. Significantly lower successful recanalization rate (OR [95%CI], 0.85 [0.76-0.95]; P=0.004; I2=0%) was detected in the off-hour group. No significant difference was noted regarding SICH and prognosis. But a trend towards lower OR of good prognosis was witnessed in the off-hour group (OR [95%CI], 0.92 [0.84-1.01]; P=0.084; I2=0%).

Conclusions

Patients who presented/were treated during off-hour were associated with excessive delays before the initiation of EVT, lower successful reperfusion rate, and a trend towards worse prognosis when compared with working hours. Optimizing the workflows of EVT during off-hour is needed.



中文翻译:

EXPRESS:非工作时间对大血管闭塞血管内治疗时间指标和临床结果的影响,系统评价和荟萃分析

背景

关于非工作时间对急性大血管闭塞 (LVO) 血管内治疗 (EVT) 的影响一直存在争议。

目标

这项荟萃分析旨在比较在非工作时间就诊/接受治疗的急性 LVO 患者与工作时间患者的时间指标和临床结果。

审查总结

对 PubMed、Embase、Web of Science 和 Cochrane 图书馆数据库的结构化搜索进行到 2021 年 2 月 23 日。主要结果是发病到门、成像门、穿刺门、穿刺到再通、手术时间、成功再通、症状性脑出血 (SICH)、住院死亡率、良好预后(90 天改良 Rankin 量表 [mRS] 评分 0-2)和 90 天死亡率。次要结果是成像到穿刺、穿刺开始、再通开始、再通时间、出院时 mRS 0-2 和连续 90 天 mRS 评分。使用随机效应模型计算结果的优势比 (OR) 和加权平均差 (WMD) 以及 95% 置信区间 (CI)。分析了异质性和发表偏倚。

2014 年至 2021 年间发表的 19 项研究共有 14185 名患者符合定量综合条件。非工作时间组患者的年龄明显小于工作时间组患者,卒中严重程度和静脉溶栓率相当。非工作时间组的起病时间更长(WMD [95%CI],12.83 [1.84-23.82] 分钟),到穿刺时间(WMD [95%CI],11.45 [5.93-16.97] 分钟),成像到穿刺(WMD [95%CI],10.39 [4.61-16.17] min),开始穿刺(WMD [95%CI],25.30 [13.11-37.50] min),开始再通(WMD [95%CI],25.16 [ 10.28-40.04] 分钟)和再通门(WMD [95%CI],18.02 [10.01-26.03] 分钟)时间。在非工作时间组中检测到显着降低的成功再通率(OR [95%CI],0.85 [0.76-0.95];P=0.004;I2=0%)。在 SICH 和预后方面未发现显着差异。但在非工作时间组中观察到预后良好的 OR 较低的趋势(OR [95%CI],0.92 [0.84-1.01];P=0.084;I2=0%)。

结论

与工作时间相比,在非工作时间就诊/接受治疗的患者与 EVT 开始前的过度延迟、较低的再灌注成功率以及预后更差的趋势相关。需要在非工作时间优化 EVT 的工作流程。

更新日期:2021-04-20
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