Mortality at 90 days in the safety population was not significantly different between groups (188/688 vs 194/713 adjusted hazard ratio, 0.97 95% CI, 0.79-1.18). Compared with patients first transported to local stroke centers, patients directly transported to thrombectomy-capable centers had significantly lower odds of receiving intravenous tissue plasminogen activator (in the target population, 229/482 vs 282/467 OR, 0.59 95% CI, 0.45-0.76) and significantly higher odds of receiving thrombectomy (in the target population, 235/482 vs 184/467 OR, 1.46 95% CI, 1.13-1.89). Of 11 reported secondary outcomes, 8 showed no significant difference. For the primary outcome in the target population, median mRS score was 3 (IQR, 2-5) vs 3 (IQR, 2-5) (adjusted common odds ratio, 1.03 95% CI, 0.82-1.29). The 1401 enrolled patients were included in the safety analysis, of whom 1369 (98%) consented to participate and were included in the as-randomized analysis (56% men median age, 75 years median National Institutes of Health Stroke Scale score, 17 ) 949 (69%) comprised the target ischemic stroke population included in the primary analysis. There were 11 secondary outcomes, including rate of intravenous tissue plasminogen activator administration and thrombectomy in the target population and 90-day mortality in the safety population of all randomized patients.Įnrollment was halted for futility following a second interim analysis. The primary outcome was disability at 90 days based on the modified Rankin Scale (mRS scores range from 0 to 6 ) in the target population of patients with ischemic stroke. Transportation to a thrombectomy-capable center (n = 688) or the closest local stroke center (n = 713). The date of final follow-up was September 2020. Multicenter, population-based, cluster-randomized trial including 1401 patients with suspected acute large-vessel occlusion stroke attended by emergency medical services in areas where the closest local stroke center was not capable of performing thrombectomy in Catalonia, Spain, between March 2017 and June 2020. To determine whether, in nonurban areas, direct transport to a thrombectomy-capable center is beneficial compared with transport to the closest local stroke center. In nonurban areas with limited access to thrombectomy-capable centers, optimal prehospital transport strategies in patients with suspected large-vessel occlusion stroke are unknown.
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