Fischer, Urs MartinUrs MartinFischerBranca, MattiaMattiaBrancaBonati, Leo HLeo HBonatiCarrera, EmmanuelEmmanuelCarreraVargas, Maria IMaria IVargasPlaton, AlexandraAlexandraPlatonKulcsar, ZsoltZsoltKulcsarWegener, SusanneSusanneWegenerLuft, AndreasAndreasLuftSeiffge, David JulianDavid JulianSeiffgeArnold, MarcelMarcelArnoldMichel, PatrikPatrikMichelStrambo, DavideDavideStramboDunet, VincentVincentDunetDe Marchis, Gian MarcoGian MarcoDe MarchisSchelosky, LudwigLudwigScheloskyAndreisek, GustavGustavAndreisekBarinka, FilipFilipBarinkaPeters, NilsNilsPetersFisch, LoraineLoraineFischNedeltchev, KrassenKrassenNedeltchevCereda, Carlo WCarlo WCeredaKägi, GeorgGeorgKägiBolognese, ManuelManuelBologneseSalmen, StephanStephanSalmenSturzenegger, RolfRolfSturzeneggerMedlin, FriedrichFriedrichMedlinBerger, ChristianChristianBergerRenaud, SusanneSusanneRenaudBonvin, ChristopheChristopheBonvinSchaerer, MichaelMichaelSchaererMono, Marie-LuiseMarie-LuiseMonoRodic, BiljanaBiljanaRodicPsychogios, MariosMariosPsychogiosMordasini, Pasquale RenatoPasquale RenatoMordasiniGralla, JanJanGrallaKaesmacher, JohannesJohannesKaesmacherMeinel, Thomas RaphaelThomas RaphaelMeinel0000-0002-0647-92732024-10-112024-10-112022-08https://boris-portal.unibe.ch/handle/20.500.12422/85240OBJECTIVE To examine rates of intravenous thrombolysis (IVT), mechanical thrombectomy (MT), door-to-needle (DTN) time, door-to-puncture(DTP) time, and functional outcome between patients with admission MRI versus CT. METHODS Observational cohort study of consecutive patients using a target trial design within the nationwide Swiss-Stroke-Registry from 01/2014 to 08/2020. Exclusion criteria included MRI contraindications, transferred patients, and unstable or frail patients. Multilevel mixed-effects logistic regression with multiple imputation was used to calculate adjusted odds ratios with 95% confidence intervals for IVT, MT, DTN, DTP, and good functional outcome (mRS 0-2) at 90 days. RESULTS Of the 11049 patients included (mean [SD] age, 71 [15] years; 4811 [44%] females; 69% ischemic stroke, 16% transient ischemic attack, 8% stroke mimics, 6% intracranial hemorrhage), 3741 (34%) received MRI and 7308 (66%) CT. Patients undergoing MRI had lower NIHSS (median [IQR] 2 [0-6] versus 4 [1-11]), and presented later after symptom onset (150 versus 123 min, P<.001). Admission MRI was associated with: lower adjusted odds of IVT (aOR 0.83, 0.73-0.96), but not with MT (aOR 1.11, 0.93-1.34); longer adjusted DTN (+22 min [13-30]), but not with longer DTP times; and higher adjusted odds of favorable outcome (aOR 1.54, 1.30-1.81). INTERPRETATION We found an association of MRI with lower rates of IVT and a significant delay in DTN, but not in DTP and rates of MT. Given the delays in workflow metrics, prospective trials are needed to show that tissue-based benefits of baseline MRI compensate for the temporal benefits of CT. This article is protected by copyright. All rights reserved.en600 - Technology::610 - Medicine & healtharticle10.48350/1702133559944210.1002/ana.26413