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. Methods and Results-In a collaborative pooled analysis of 7 endovascular databases, we assessed the impact of onsetto-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. Conclusion-Onset-to-reperfusion time affects mortality and favorable outcome and should be considered the main goal in acute stroke patient management. (Circulation. 2013;127:1980-1985 13 A pooled analysis of the 2 IMS trials 3 and a single-center experience study 2 have previously reported the impact of ORT on good clinical outcome, but none has studied associations with 90-day mortality. The methodologies (study period, treatment specificities, baseline characteristics, and outcomes) of the 7 studies are summarized in Table 1. Eligibility, Data Collection, and DefinitionsPatients were eligible for inclusion in this study if they (1) had a largeartery occlusion (intracranial internal carotid artery or middle cerebral artery, M1 or M2) treated by an endovascular approach (thrombolysis or mechanical endovascular therapy) with or without prior use of intravenous thrombolysis; (2) had a successful angiographic reperfusion within 8 hours from symptom onset, defined as a complete or partial restoration of blood flow (Thrombolysis in Myocardial Infarction grade 2-3) 14 ; and (3) had available information on vital status. Data from individual patients were collected on a standardized form with predefined variables and were compiled and analyzed at the coordinating center (University Bichat Hospital, Paris). The following variables were collected: age; sex; initia...

Objective To determine the predictive value of discharge destination as a surrogate for defining unfavorable outcome at 3- and 12-months poststroke. Design Analysis of the prospectively collected data from a randomized, placebo-controlled trial in patients with ischemic stroke presenting within 3 hours of symptom onset. Setting Post hoc analysis of patients recruited in a clinical trial. Participants Patients (N=530) discharged alive from the hospital after ischemic stroke. Interventions Not applicable. Main Outcome Measures Positive and negative predictive value and likelihood ratios of discharge destination for unfavorable outcome at 3- and 12-months poststroke defined by a Modified Rankin Scale (MRS) score of 2 to 6, 3 to 6, or 4 to 6. A likelihood ratio indicates how many times more (or less) likely a particular discharge destination is seen in patients with an unfavorable outcome compared with those without unfavorable outcome. Results The positive predictive value of nursing home and rehabilitation facility discharges was highest for unfavorable outcome defined by an MRS score of 2 to 6 (95%) and rehabilitation facility (89%) at 3-months poststroke, respectively. The positive predictive value of rehabilitation facility/nursing home (90%) was also highest for unfavorable outcomes defined by an MRS score of 2 to 6 compared with those defined by MRS scores of 3 to 6 (79%) and 4 to 6 (57%). The positive likelihood ratio was highest for nursing home discharges (13; 95% confidence interval [CI], 4.1– 41) followed by rehabilitation facility discharges for unfavorable outcome defined by an MRS score of 2 to 6 at 3-months poststroke (5.3; 95% CI, 3.5–7.9). The negative likelihood ratio was the highest for home discharge for unfavorable outcome defined by an MRS score of 2 to 6 (4.5; 95% CI, 3.4 – 6.1). A similar pattern was observed with unfavorable outcome defined using various thresholds at 12 months. Conclusions Discharge destination can provide high predictive values and likelihood ratios for death and disability at 3-months poststroke, as defined by an MRS of score of 2 to 6.