Abstract WMP54: Outcomes of acute ischemic stroke patients in primary stroke centers versus comprehensive stroke centers: a pre-specified analysis of the Alteplase compared to Tenecteplase trial
Bibliographic record
Abstract
Background and Objectives: Transportation to comprehensive stroke centers (CSCs) from primary stroke centers (PSCs) is key to achieving fast reperfusion in endovascular treatment (EVT)-eligible patients. We aimed to evaluate outcomes and workflow times of patients treated PSCs vs CSCs and additional key metrics for those transported from PSCs to CSCs for EVT. Methods: We performed a pre-specified analysis of the Alteplase compared to Tenecteplase (AcT) multicenter, randomized, controlled, trial in patients with acute ischemic stroke within 4.5 hours of onset. We compared baseline characteristics, workflow times, and clinical outcomes at 90 days between PSCs and CSCs. Mixed effects regression analyses were performed adjusting for age, sex, National Institute of Health Stroke Scale (NIHSS), location of intracranial occlusion, IVT drug and door-to-needle-time as fixed effects; and study site as a random effect. Results: Of 1,577 patients enrolled in the trial, 99 (6.27%) were treated in PSCs while 1,478 (93.72%) were treated in CSCs. Patients in both groups had similar age (median 72 [64 - 82] vs 74 [63 - 83] years), proportion of females (42.42% vs 48.24%), baseline stroke severity (median NIHSS 9 [6 - 16] vs 10 [6 - 16.5]), presence of large vessel occlusion (24.24% vs 24.70%; p=0.919) and EVT utilization (24.24% vs 32.61%). Patients treated in PSCs had longer onset-to-needle (median, 139 [100 - 190] vs 128 [94 - 185] minutes) and door-to-needle times (median, 56.5 [42 - 70] vs 35 [27 - 47] minutes) compared to those treated at CSCs. For patients transferred from PSCs to CSCs, patients who received tenecteplase had shorter needle-to-puncture times than those who received alteplase (median, 35.5 [21 - 58] vs 52 [18 - 74] minutes, p<0.001). The proportion of patients achieving excellent functional outcome (mRS 0-1) at 90 days was higher at PSCs compared to CSCs (48.48% vs 35.01%, adjusted IRR, 1.42 [CI 95%, 1.04 - 1.95]). Conclusions: Despite less efficient workflows for IVT administration and similarities in baseline characteristics, the proportion of patients receiving initial treatment in PSCs who had excellent functional outcomes was higher compared to CSCs. Among those who received tenecteplase prior to CSC transfer, more efficient time metrics were noted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.013 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.008 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".