Abstract 60: Utilization, Workflow, and Outcomes of Endovascular Thrombectomy in Patients With versus Without Pre-Morbid Disability in a National Stroke Registry
Aravind Ganesh, Ondrej Volny, Ingrid Kovacova, Ales Tomek, Michal Bar, Miloslav Rocek, Radek Padr, Filip Cihlar, Miroslava Nevsimalova, Lubomír Kocí, Roman Havlicek, Martin Kovar, Petr Sevcik, Vladimir Rohan, Jan Fiksa, David Cernik, Rene Jura, Daniel Vaclavik, Michael D Hill, Robert Mikulik- Advanced and Specialized Nursing
- Cardiology and Cardiovascular Medicine
- Neurology (clinical)
Background: Given the paucity of high-quality data on acute stroke therapies in patients with pre-morbid disability, they risk being routinely excluded from such therapies. We examined utilization of endovascular thrombectomy (EVT), workflow, and outcomes among ischemic stroke patients with vs without pre-morbid disability in a national registry.
Methods: We used data for the Czech Republic from 1-January-2016 to 31-December-2020. Pre-morbid disability was defined as pre-stroke modified Rankin Scale score (mRS) >2. We compared receipt of EVT, workflow times, ΔmRS (change from pre-stroke to 3-months), intracerebral hemorrhage (ICH), mortality, and discharge NIHSS among patients with vs without pre-morbid disability, adjusting for age, sex, baseline NIHSS, and comorbidities, and verified using propensity score-weighting (PSW) for differences in treatment assignment.
Results: Among 22,405 patients, 1,712 (7.6%) had pre-stroke mRS >2. Patients with pre-morbid disability were less likely to receive EVT (10.1% vs 20.7%, aOR:0.30, 95%CI:0.24-0.36) and had longer door-to-puncture times (median:75-minutes, IQR:58-100 vs 54, IQR:27-77, adjusted-difference:12.5, 95%CI:2.68-22.3), worse ΔmRS (adjusted rate-ratio, aIRR on PSW:1.57, 1.43-1.72), rates of 3-month mRS 5-6, discharge NIHSS, and mortality (aOR-PSW[mortality]:2.54, 1.92-3.34); ICH rates did not differ. Among those with pre-morbid disability, 32.1% returned to pre-stroke state; this ranged from 19.6% for those >85-years to 66.0% for <65-years. EVT was associated with better outcomes including lower ΔmRS (aIRR-PSW:0.87, 0.83-0.91) and mortality, with no interaction of treatment effect by pre-morbid disability (e.g. mortality p interaction =0.73). EVT recipients with pre-morbid disability did not differ significantly for several key outcomes including ΔmRS (aIRR:0.99, 0.84-1.17), but were more likely to have mRS 5-6 (70.1% vs 39.5%, aOR:1.85, 1.12-3.04).
Conclusions: Patients with pre-morbid disability were less likely to receive EVT and had slower treatment and worse outcomes than those without disability. However, patients fared better with EVT versus medical care, and one-third with pre-stroke disability returned to their pre-stroke state.