ESO East Supplement 2023 - 9

Palaiodimou et al.
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one (General Hospital of Kalamata, which contributed only
eight patients overall) were administering IVT, while EVT
was available and performed by eight sites. Regarding the
patients receiving IVT, DTN time was 40 min (IQR 7-58),
and for those undergoing EVT, DTG time was 64 min (IQR
16-116). Shortening of DTN time was observed in sites
that maintained patients' registration for 5 years with more
than 85% of patients receiving IVT within 60 min compared
to sites that included patients in the registry for less
than 5 years (76%, p < 0.001). DTG time was not associated
with the duration of registry participation (p = 0.480),
possibly due to the small number of procedures. Continuous
registry participation was not shown to correlate with the
rates of acute reperfusion treatment administration
(p = 0.152). However, when adjusted for contributing sites,
the rates of acute reperfusion therapies were higher during
the time epoch 2020-2021 compared to the time epoch
2017-2019, despite the COVID-19 pandemic (adjusted OR
1.31; 95% CI 1.04-1.64; p < 0.022; Cochran-MantelHaenszel
test).
Less than 1/3 (31%) of the patients were admitted in a
dedicated stroke unit or ICU, while the majority (67%)
were hospitalized in standard beds in neurological wards or
other general wards. Acute reperfusion therapies were associated
with higher odds of admission in Stroke Unit/ICU
(OR 2.67; 95% CI 2.42-2.95; p < 0.001), with almost 2/3
(63%) of the patients receiving IVT, EVT, or bridging therapy
being hospitalized in Stroke Units/ICUs. Furthermore,
hospitalization in Stroke Unit/ICU was also related with the
maintenance of stroke registry by the contributing sites,
with higher rates of admission in Stroke Unit/ICU for sites
that continued patients' registration for 5 years (54%) compared
to sites that withdrew from the registry during the
5-year period (16%, p < 0.001). Dysphagia screening test
was performed within the first 24 h of hospitalization in
almost 80% of patients, while 3.8% of patients needed
mechanical ventilation during hospitalization.
Screening for atrial fibrillation (AF) was performed in
84.9% of AIS and TIA patients, leading to the detection of
AF in 7.2% of patients, either at admission or during hospitalization.
Prior history of AF was present in 12.2%, while
the presence of AF was not investigated in 15.1% of the
patients. Screening for AF significantly varied across the
contributing sites (p < 0.01; χ2 test), with four sites registering
more than half of their patients as unknown AF status.
Carotid arteries imaging within 7 days of the index
event was performed in 83.4% of AIS and TIA patients, out
of whom 9.2% displayed a hemodynamically significant
carotid stenosis (>50%). Carotid endarterectomy or angioplasty/stenting
was performed during the acute phase
(within the first 2 weeks after stroke onset) in 28.1% of the
patients with symptomatic carotid stenosis, while another
5.9% was referred to another center for acute management.
Finally, rehabilitation evaluation was performed in 57.6%
of patients within the first 72 h post-stroke.
Eleven centers presented data regarding the COVID-19
status of their patients during the first 2 years of the pandemic
(2020-2021). In early 2020, screening for COVID-19
was restricted to patients that presented COVID-19associated
symptoms due to testing capacity limits, leading
to an unknown status of COVID-19 in 60% of the hospitalized
stroke patients. However, in 2021, a massive screening
program for all inpatients was implemented and more than
92% (n = 786) of the stroke patients were tested, out of
whom 1.7% (n = 14) tested positive for COVID-19.
After a median of 5 days of hospitalization (IQR 7), 78%
of patients were discharged home, while 17.5% were transferred
to another department or to a social care facility, for
further rehabilitation. Antithrombotics were prescribed in
95.8% of AIS or TIA patients, while statin treatment was
initiated in 79.2% of them. Among patients with AF-related
AIS or TIA, 73% were prescribed anticoagulants, 12.5% of
them were treated with vitamin-K antagonists, 80.7% were
treated with direct oral anticoagulants, and 6.8% received
low molecular weight heparin at therapeutic dose.
Antihypertensive treatment was prescribed in 66.8% of
stroke patients. Smoking cessation was recommended in
81.1% of stroke patients that had history of smoking. Upon
discharge, follow-up appointment with a cerebrovascular
expert was scheduled in 63.7% of patients.
Median mRS score at discharge was 1 (IQR 0-3). An
excellent clinical outcome at discharge was achieved in
60.1% of patients and a good clinical outcome at discharge
was noted in 71.3%. In-hospital
mortality was 3.1%.
Baseline characteristics, management, and clinical outcomes
at discharge are summarized in Table 2.
With respect to AIS patients, a propensity score matched
(PSM) analysis was performed, in order to balance for
baseline differences that could influence the likelihood of
receiving acute reperfusion therapy. After PSM analysis,
296 patients that received reperfusion therapy were matched
to 296 controls, resulting in no differences regarding demographic
factors (age, gender), baseline characteristics (inhospital
stroke, recurrent stroke, initial stroke severity), and
contributing site (Table 3). In this matched population, reperfusion
therapy was positively associated with both excellent
clinical outcomes (OR 1.88; 95% CI 1.35-2.61;
p < 0.001) and good clinical outcomes at discharge (OR
1.95; 95% CI 1.40-2.72; p < 0.001; Figure 2). After propensity
score matching, acute reperfusion therapies were
independently associated with higher odds of reduced disability
(one point reduction across all mRS scores) at hospital
discharge (common OR 1.93; 95% CI 1.45-2.58;
p < 0.001; Figure 3). Finally, delivery of acute reperfusion
therapy was not associated with in-hospital mortality (OR
0.87; 95% CI 0.31-2.44; p = 0.794).
ESO East Supplement 2023

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