Background and Aims
Trials and metanalyses have all shown a time-dependent effect in the benefits of reperfusion therapies. However, the role of prehospital delay (PD) in the prognosis of patients who don’t qualify for reperfusion therapies has rarely been addressed. We conducted a study to investigate if a sooner hospital arrival (PD < 3 hours) favors functional independency (mRS < 2) three months after a stroke.

Method
284 Patients with acute stroke (TIA excluded) who didn’t receive thrombolysis nor thrombectomy were prospectively included. Sociodemographic factors, premorbid conditions, and clinical, biochemical and hematological parameters that were considered as possible prognostic factors were collected, as well as data on PD. Multivariate logistic regression analyses were conducted to identify factors related to achieving functional independency three months after stroke.

Results
A PD of three hours or less increased the chance of achieving a mRS of 2 or less three months after stroke onset (OR 5,478; CI 95% 1,998-15,018;p=0,001) as did higher serum triglycerides level (OR 1,010;CI 95% 1,001-1,019;p=0,044). Inhospital infectious comorbidities (OR 0,132;CI 95% 0,042-0,416;p=0,001), active smoking (OR 0,182;CI 95% 0,050-0,658;p=0,009), female gender (OR 0,374;CI 95% 0,154-0,911;p=0,030), and higher scores on previous mRS (OR 0,226;CI 95% 0,150-0,342;p<0,001) and initial NIHSS (OR 0,829;CI 95% 0,755-0,910;p<0,001) predicted dependency.

Conclusion
Time is a key prognostic factor for patients undergoing reperfusion therapies as well as for those who don’t qualify for them. Future interventions should be directed towards increasing the number of patients arriving the hospital in the first three hours, which would not only increase thrombolysis and thrombectomy rates, but also help achieving functional independency three months after stroke.

TIME DEPENDENT BENEFIT IN HOSPITAL ATTENTION FOR STROKE PATIENTS NOT RECEIVING REPERFUSION THERAPIES