title: Impact of onset-to-reperfusion time on stroke mortality: a collaborative pooled analysis.
abstract: BACKGROUND
  Onset-to-reperfusion time has been reported to be associated with clinical prognosis. However, its impact on mortality remained to be assessed. Using a collaborative pooled analysis, we examined whether early mortality after successful endovascular treatment is time dependent.
  
  
  RESULTS
  In a collaborative pooled analysis of 7 endovascular databases, we assessed the impact of onset-to-reperfusion time in large-artery occlusion (internal carotid artery or middle cerebral artery) on outcomes. Successful reperfusion was defined as complete or partial restoration of blood flow within 8 hours from symptom onset. Primary outcome was 90-day all-cause mortality. Secondary outcomes included 90-day favorable outcome (modified Rankin Scale score, 0-2), 90-day excellent outcome (modified Rankin Scale score, 0-1), and occurrence of any intracerebral hemorrhage within 24 to 36 hours after treatment. A total of 480 cases with successful reperfusion (median time, 285 minutes) contributed to the present pooled analysis (120 with internal carotid artery occlusion and 360 with isolated middle cerebral artery occlusion). Increasing onset-to-reperfusion time was associated with an increased rate of mortality and intracerebral hemorrhage and with a decreased rate of favorable and excellent outcomes, without heterogeneity across studies. The adjusted odds ratio for each 30-minute time increase was 1.21 (95% confidence interval, 1.09-1.34; P<0.001) for mortality, 0.79 (95% confidence interval, 0.72-0.87) for favorable outcome, 0.78 (95% confidence interval, 0.71-0.86) for excellent outcome, and 1.21 (95% confidence interval, 1.10-1.33) for intracerebral hemorrhage.
  
  
  CONCLUSIONS
  Onset-to-reperfusion time affects mortality and favorable outcome and should be considered the main goal in acute stroke patient management.
authors.affiliation: Department of Neurology and Stroke Centre, Bichat University Hospital, 46, Rue Henri Huchard, 75018 Paris, France. mikael.mazighi@bch.aphp.fr
authors.forename: Mikael
authors.initials: M
authors.lastname: Mazighi
authors.forename: Saqib A
authors.initials: SA
authors.lastname: Chaudhry
authors.forename: Marc
authors.initials: M
authors.lastname: Ribo
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.forename: David
authors.initials: D
authors.lastname: Skoloudik
authors.forename: Maxim
authors.initials: M
authors.lastname: Mokin
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Elena
authors.initials: E
authors.lastname: Meseguer
authors.forename: Sharon D
authors.initials: SD
authors.lastname: Yeatts
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.forename: Joseph
authors.initials: J
authors.lastname: Broderick
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Molina
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
mesh_terms: D003299:Cooperative Behavior; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D010865:Pilot Projects; D011446:Prospective Studies; D015424:Reperfusion / Q000379:methods*; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: meta-analysis; stroke; stroke reperfusion injury