Abstract WP41: Age-Specific Differences in the Use of Endovascular Treatment and Hospital Outcomes in Patients With Acute Ischemic Stroke: A Community-Wide Perspective

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Iqra N Akhtar ◽  
Ameer E Hassan ◽  
Mohammad Rauf A Chaudhry ◽  
Mohsain Gill ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
International Classification Of Diseases ◽  
The United States ◽  
Primary Diagnosis ◽  
Limited Information ◽  
Hospital Outcomes ◽  
The Impact ◽  
Over Time

Background: Relatively limited information is available about trends over time in the use of endovascular treatment in patients of different ages hospitalized with acute ischemic stroke and the association between use of thrombectomy treatment and hospital outcomes in age strata. We performed this analysis to evaluate trends in the utilization of endovascular treatment in acute ischemic stroke by age strata in real-world practice. Methods: We conducted this study by identifying patients admitted with a primary diagnosis of ischemic stroke in the United States from 2007 to 2016 using the Nationwide Inpatient Sample. International Classification of Diseases, ninth revision, and tenth, Clinical Modification (ICD-9-CM, ICD-10-CM) codes were used to identify patients admitted for ischemic stroke and undergoing endovascular treatment. Results: Of the 4,590,533 patients admitted with ischemic stroke, 269,922 (5.88%) received intravenous thrombolytic treatment, and 51,375 (1.12%) underwent endovascular treatment. There is almost 12-fold significant increase in the use of endovascular treatment patients admitted with acute ischemic stroke between 2007 to 2016. Patients who were 75 years and older experienced a marked increase in the receipt of endovascular treatment over time (0.12% 2007; 1.91% 2016; trend p<0.0001). We observed statistically significant improvement in outcomes including minimal disability (6.3% to 18.8%; trend p<0.0001) and in hospital mortality (25.0% to 16.5%; trend p<0.0001) in patients 75 years and older treated with endovascular treatment in study period. We observed similar trend of outcomes in each of the other age-specific groups under study (<55, 55-64 and 65-74 years). Conclusions: Our findings indicate a recent increase in the use of endovascular in middle-aged and elderly patients with acute ischemic strokes. The impact of endovascular treatment on hospital outcomes was observed in each of our age strata understudy though the magnitude of absolute and relative benefit varied according to age.

Abstract WP284: National Trends in Utilization and Outcomes of Thrombolytic Use by Drip and Ship Paradigm in Acute Ischemic Stroke Patients in United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Mohammad Rauf A Chaudhry ◽  
Mohsain Gill ◽  
Iqra N Akhtar ◽  
Adnan I Qureshi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Severe Disability ◽  
Multivariate Logistic Regression Model ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Hospital Outcomes

Background and Purpose: The drip and ship paradigm has rapidly expanded in the last decade allowing higher thrombolytic utilization and endovascular treatment. We performed this analysis to evaluate trends in utilization of drip and ship paradigm in United States and associated outcomes. Methods: We analyzed data for patients admitted with primary diagnosis of ischemic stroke in the United States from Nationwide Inpatient Sample, the largest nationally representative data, for the years 2009 to 2015. We studied changes in utilization of drip-and-ship paradigm and subsequent performance of endovascular treatment, and rates of discharge with none to minimal disability and moderate to severe disability. Results: Of the 3,043,190 patients admitted with ischemic stroke, 56,449 (1.85%) patients received thrombolytic treatment through drip-and-ship paradigm over a 7 year period. Of all patients who received thrombolytic treatment (n=243,824), 56,449 (23.15%) received using drip and ship paradigm. There was almost 3 fold increase in drip and ship paradigm (in 0.98% 2009 to 2.80% in 2015 (test for trend= p < 0.001). Among the patients who underwent drip and ship paradigm, 5,061 (8.97%) underwent endovascular treatment. The rate of endovascular treatment increased from 6.62% to 12.39% among patients treated with drip and ship paradigm (test for trend= p < 0.001). The rate of none minimal disability at discharge increased from 39.93% to 47.08%, (test for trend p < 0.001) while moderate to severe disability decreased 51.22% to 47.08%, (test for trend p < 0.001) in ischemic stroke patients treated using drip-and-ship paradigm. Similar trends were observed for hospital outcomes in multivariate logistic regression model, adjusted for age, gender, medical comorbidities and secondary intracranial hemorrhages. Conclusion: There has been a significant increase in the proportion of acute ischemic stroke patients treated using drip-and-ship paradigm (out of proportion to overall thrombolytic use) with increase in subsequent endovascular treatment in United States. The in hospital outcomes of patients have improved perhaps due to higher utilization of endovascular treatment.

Abstract MP25: Inequities in Interhospital Transfer for Acute Ischemic Stroke in the United States: Lower Odds for Women and the Underinsured

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Daniel M Oh ◽  
Daniela Markovic ◽  
Amytis Towfighi
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Multinomial Logistic Regression ◽  
Private Insurance ◽  
Stroke Care ◽  
The United States ◽  
Primary Diagnosis ◽  
Multinomial Logistic Model ◽  
Lower Odds ◽  
Interhospital Transfer

Background: Patients with acute ischemic stroke (AIS) may undergo interhospital transfer (IHT) for higher level of care. Although the Emergency Medical Treatment and Active Labor Act stipulates that patients should be transferred to and accepted by referral hospitals if indicated, it offers few concrete guidelines, making it vulnerable to bias. We hypothesized that (1) IHT for AIS has increased over recent years and (2) minorities, women, and those without insurance had lower odds of IHT. Methods: Using the National Inpatient Sample, adults (>18 yrs) with a primary diagnosis of AIS from 2010 to 2017 (n=770,970) were identified, corresponding to a weighted sample size of 3,798,440. Those transferred to another acute hospital were labeled IHT. Yearly rates of IHT were assessed. Adjusted odds ratio (AOR) of IHT (vs. not transferred) were compared in 2014-2017 vs. 2010-2013 using a multinomial logistic model, adjusting for socioeconomic, medical, and hospital characteristics. Multinomial logistic regression was used to determine odds of IHT by race/ethnicity, sex, and insurance status, adjusting for the above characteristics. Results: From 2010 to 2017, the proportion of IHT declined from 3.2% (SE 0.2) to 2.9% (SE 0.1). Comparing IHT in 2014-2017 to 2010-2013 showed lower odds of IHT (OR 0.93, 95% CI 0.88-0.99), but this difference did not remain significant in the fully adjusted model. Fully adjusted OR showed that black patients were more likely than white patients to undergo IHT (AOR 1.13, 1.07-1.20). Women were less likely than men to be transferred (AOR 0.89, 0.86-0.92). Compared to those with private insurance, those with Medicaid (AOR 0.86, 0.80-0.91), self-pay (0.64, 0.59-0.70), and no charge (0.64, 0.46-0.88) were less likely to undergo IHT. Conclusions: Adjusted odds of IHT for AIS did not change significantly. Blacks were more likely than whites to be transferred; however, women and the uninsured/underinsured were less likely to be transferred. Further studies are needed to further understand these inequities and develop interventions and policies to ensure that all individuals have equitable access to stroke care, regardless of their race, sex, or ability to pay.

Abstract P338: Cardiovascular And Cerebrovascular Events Associated With Cancer Surgery In The United States

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Anshul Saxena ◽  
Muni Rubens ◽  
Venkataraghavan Ramamoorthy ◽  
Sankalp Das ◽  
Chintan B Bhatt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perioperative Period ◽  
The United States ◽  
National Database ◽  
Perioperative Morbidity ◽  
Cerebrovascular Events ◽  
Colon And Rectum ◽  
National Trends ◽  
Over Time

Background: Major adverse cardiovascular and cerebrovascular events (MACCE) are significant causes of perioperative morbidity and mortality but, the incidence and effects following cancer surgeries are unknown. The aims of this study were to evaluate national trends in MACCE after major cancer surgeries and to identify cancer types associated with cardiovascular events using a large national database. Methods: Patients who had major cancer surgeries from 2005 to 2014 were identified from the National Inpatient Sample database. Hospitalizations for surgeries for cancer of prostate, bladder, esophagus, pancreas, lung, liver, breast, colon and rectum were identified by ICD9 diagnosis and procedure codes. The main outcome was perioperative MACCE, defined as in-hospital, all-cause death, acute myocardial infarction (AMI), or acute ischemic stroke, and was evaluated over time. Results: Among 2,854,810 hospitalizations for major cancer surgeries, perioperative MACCE occurred in 67,316 hospitalizations (2.4%). Mean (SE) age of patients was 65.4 (0.07) years and 54.2% were male patients. MACCE occurred most frequently in patients undergoing surgeries for lung (6.8%), pancreatic (4.5%), and colorectal (3.3%) cancers. Between 2005 and 2014, the frequency of MACCE declined from 2.7% to 2.2% ( P <0.001) and was driven by a decline in the frequency of perioperative death ( P <0.001) and AMI ( P = 0.002). However, no significant changes were observed for acute ischemic stroke ( P = 0.6) during the study period. Conclusion: Perioperative MACCE occurs in 1 out of every 42 hospitalizations for major cancer surgeries. Despite reductions in the rate of death and AMI among patients undergoing major cardiac surgeries, perioperative ischemic stroke remained constant over time. The lack of improvements in perioperative ischemic stroke rate is concerning and requires additional interventions. Significant efforts should be directed towards improving cardiovascular care during the perioperative period of cancer surgeries.

Abstract 2311: Hospitalization Costs of Stroke among Adults 18-64 Years in the United States

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Guijing Wang ◽  
Zefeng Zhang ◽  
Carma Ayala ◽  
Diane Dunet ◽  
Jing Fang ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Late Effects ◽  
Average Cost ◽  
Hemorrhagic Stroke ◽  
The United States ◽  
Primary Diagnosis ◽  
Secondary Diagnosis ◽  
Hospitalization Costs ◽  
The Impact

Background and purpose: The average cost of stroke, a leading cause of death and serious long-term disability, has been estimated to range from $468 to $146,149 worldwide, and varies 20-fold in the United States. A robust cost estimate is needed for policy makers, public health researchers and practitioners to use as a reference in making resource allocation decisions and assessing cost-effectiveness of intervention programs. This study examined the hospitalization costs of stroke using a large administrative data. Methods: We identified 97,374 hospitalizations with a primary or secondary diagnosis of stroke from pooling 2006-2008 MarketScan inpatient datasets. We investigated the costs by stratifying the hospitalizations by stroke types (hemorrhagic ICD-9 430-432, ischemic ICD-9 433-434, ill-defined ICD-9 436-437, and late-effects ICD-9 438) and diagnosis status (primary and secondary). For hospitalizations with stroke as the primary diagnosis, we identified those with a secondary diagnosis of hypertension, ischemic heart disease (IHD), and diabetes. We used multiple regression models to estimate the impact of stroke types and diagnosis status on the costs controlling age, sex, geographic region, and Charlson Comorbidity Index (CCI). Results: Of the 97,374 hospitalizations (average cost $20,396 ±23,256), the number of hospitalizations with hemorrhagic, ischemic, ill-defined, and late-effects of stroke was 16,331, 62,637, 38,312, and 14,221 with an average cost of $32,035 ±32,046, $18,963 ±21,454, $19,430 ±22,159, and $18,946±19,891, respectively. Over 61% of the hospitalizations listed stroke as a secondary diagnosis only. Regression results showed that the costs increased by at least $962 per CCI unit increase (p<0.001). Hemorrhagic stroke cost $14,499 more than ischemic stroke (p<0.001). For hospitalizations with the primary diagnosis of stroke, those with a secondary diagnosis of IHD had higher costs than those without IHD, especially among those of ischemic stroke ($9835 higher, p<0.001), while hypertension and diabetes as a secondary diagnosis lowered the costs. Hospitalizations with a primary diagnosis of ischemic stroke had $3195 lower cost than those listed as secondary diagnosis, but hospitalizations with a primary diagnosis of hemorrhagic stroke had $8001 higher cost than those listed as a secondary diagnosis. Conclusions: The costs of stroke hospitalizations were high and varied greatly by stroke types, diagnosis status, and comorbidities. Stroke types and their comorbidities should be considered when developing cost-effective strategies for stroke prevention.

Abstract WMP94: Temporal Trends in Racial, Age, and Sex-Specific Utilization of Decompressive Hemicraniectomy Among Acute Ischemic Stroke Patients in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sai P Polineni ◽  
Fadar O Otite ◽  
Seemant Chaturvedi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Temporal Trends ◽  
Age Groups ◽  
The United States ◽  
Decompressive Hemicraniectomy ◽  
Study Results ◽  
Over Time ◽  
Age And Sex

Background: The aim of this study is to evaluate current trends in racial, age, and sex-specific utilization of decompressive hemicraniectomy (HC) in acute ischemic stroke (AIS) patients in the United States over the last decade. Methods: All adult patients with a diagnosis of AIS were identified from the 2004-2015 Nationwide Inpatient Sample (weighted N=4,792,428) using International Classification of Diseases Ninth revision (ICD-9) codes. Proportion of patients undergoing HC in various age, race, and sex groups were ascertained using ICD-9 procedural codes. Temporal trends were mapped by year in order to track changes in utilization over time. Analysis of utilization disparities and trends within age, sex, and race subgroups was conducted via multivariate logistic regression. Results: Of all eligible AIS patients from 2004-2015, 0.25% underwent HC (.08 in 2004 to .46 in 2015). Increased utilization over time was seen in both men (.13 to .57) and women (.08 to .54), with women showing comparable odds of utilization to men [OR: 0.95 (95% CI: .87-1.04, p=0.27)]. Similarly, increased utilization trends were seen in all age groups (Figure 1) with the highest rates in the 18-39 subgroup (1.41%). Compared to trends in this younger subgroup (.43 to 2.12), patients aged 60-79 experienced a similar overall increase but at lower utilization rates (.06 to .37). Compared to white patients in multivariate models, blacks did not show significant differences in odds of HC [1.09 (.96-1.24, p=0.20)], while patients from Hispanic [1.25 (1.03-1.51, p=0.02)] and other [1.26 (1.04-1.52, p=0.02)] race-ethnic groups showed increased odds. Conclusions: From 2004-2015, hemicraniectomy rates have seen substantial increases in all age, sex, and race groups. The increasing rates of hemicraniectomies among those over age 60 suggest that there has been at least partial acceptance of DESTINY 2 study results.

Abstract P76: Effect of Covid-19 Pandemic on Acute Ischemic Stroke Hospitalizations Among Medicare Beneficiaries in the United States

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Quanhe Yang ◽  
Xin Tong ◽  
Sallyann Coleman King ◽  
Robert K Merritt
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Primary Diagnosis ◽  
Emergency Department Visits ◽  
Fee For Service ◽  
Long Term Effects ◽  
Percent Reduction ◽  
Race Ethnicity

Introduction: Emergency department visits and hospitalizations for acute ischemic stroke (AIS) declined significantly following the declaration of COVID-19 as a national emergency on March 13, 2020 in the United States. No study has examined the volume and nature of AIS hospitalizations among older adults in the U.S. amidst the COVID-19 pandemic. This study examined the trend and compared the characteristics of Medicare fee-for-service (FFS) beneficiaries ≥65 years hospitalized with a primary AIS diagnosis in the same timeframe before and after the COVID-19 pandemic. Methods: We included hospitalizations with a primary diagnosis of AIS (ICD-10 I63) among Medicare FFS beneficiaries from week 11 to 24 in 2019 and 2020. We estimated the percent reduction of AIS hospitalizations between 2019 and 2020 by age, sex, race/ethnicity, and state. We tested for difference in distribution by age group, sex and race/ethnicity between 2019 and 2020 based on χ 2 test. Results: During the 14-weeks from March 8 to June 13, 2020, AIS hospitalizations among FFS beneficiaries were reduced by 23.7% compared to weeks 11 to 24 in 2019 (March 10 to June 15) (49,607 in 2019 vs. 37,860 in 2020). A greater percent reduction in AIS hospitalizations was observed with older age (27.2% among ≥85 years vs. 20.6% among persons 65-74 years, p<0.001). The magnitude of reduction was similar between men (23.8%) and women (23.6%, p=0.791), and among non-Hispanic white (24.2%), non-Hispanic black (22.4%), Hispanic (19.3%), and other (22.4%, p=0.189). AIS hospitalization trends varied by state ranging from 1.6% in New Hampshire to 39.8% in Montana. Conclusion: Hospitalizations with a primary AIS diagnosis among Medicare FFS beneficiaries were reduced by 24% during weeks 11 to 24 of the COVID-19 pandemic compared to the previous year in the United States. AIS hospitalization reductions varied substantially by state. Further study is needed to examine the long-term effects of COVID-19 pandemic on stroke outcomes.

Abstract 196: Thrombolytic Treatment using Drip and Ship Treatment Paradigm among Acute Ischemic Stroke Patients in the United States: Outcomes and impact on regional thrombolytic utilization and referral patterns

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Wondwossen G Tekle ◽  
Saqib A Chaudhry ◽  
Habib Qaiser ◽  
Ameer E Hassan ◽  
Gustavo J Rodriguez ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Referral Patterns ◽  
Hospital Outcomes ◽  
Treatment Paradigm

Background: While single center and regional estimates of thrombolytic administration using drip and ship treatment paradigm are available, patient outcomes, thrombolytic utilization, cost, and referral patterns has not been assessed in United States. Objective: To provide national estimates of patients treated with thrombolytics using drip and ship paradigm and determine the impact of drip and ship treatment on regional thrombolytic utilization, treatment cost, and referral patterns of acute stroke patients in a large cohort. Methods: We determined the proportion of patients treated with drip and ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment and obtained comparative in-hospital outcomes from the Nationwide Inpatient Survey (NIS) data files from October 2008 to December 2009. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Thrombolytic utilization, hospitalization cost, and patterns of referral related to drip and ship treatment of acute stroke were estimated. Results: Of the 26,814 ischemic stroke patients who received thrombolytic treatment, 5144 (19%) were treated using drip and ship paradigm. Seventy nine percent of all the drip and ship treated patients were referred to urban teaching hospitals for further care, and 7% of them received follow up endovascular treatment at the referral facility. States with higher proportion of patients treated using the drip and ship paradigm had higher rates of thrombolytic utilization (3.1% vs. 2.4%, p<0.001). After adjusting for age, gender, presence of hypertension, diabetes mellitus, renal failure, and hospital teaching status, outcomes of patients treated with drip and ship paradigm was similar to those who received thrombolytic and stayed in the same facility: self care (odds ratio [OR], 1.055, 95% confidence interval [CI], 0.910-1.224, p=0.4779); death(OR , 0.821 95% CI, 0.619- 1.088, p=0.1688); and nursing home discharge (OR, 1.023, 95% CI, 0.880- 1.189, p=0.7659) at discharge. Drip and ship paradigm was associated with shorter hospital stay (mean [days, SE] 5.9± 0.18 vs. 7.4 ± 0.15, p<0.001), and lower cost of hospitalization (mean total charges [$, SE) 57,000 ± 3,324 vs. 83,000 ± 3,367, p<0.001). Conclusions: One out of every five patients who received thromboytic treatment in United States is currently treated using drip and ship paradigm with comparable adjusted rates of favorable outcomes. There was a higher rates of thrombolytic utilization in States where drip and ship was more commonly implemented.

Diagnostic Yield of Electroencephalography When Seizure Is Suspected in Acute Ischemic Stroke

2021 ◽  
pp. 194187442110212
Author(s):  
Mohanad AlGaeed ◽  
Manjot Grewal ◽  
Prarthana Hareesh ◽  
Soha Sadeghikhah ◽  
Hai Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diagnostic Yield ◽  
Care Center ◽  
Tertiary Care ◽  
Secondary Analysis ◽  
Retrospective Chart Review ◽  
The United States ◽  
Primary Diagnosis ◽  
Eeg Monitoring

Introduction: Seizures are a common complication after an ischemic stroke. Electroencephalography can assist with the diagnosis of seizures however, the diagnostic yield of its use when seizure is suspected in the setting of acute ischemic stroke is unknown. We aim to evaluate the yield and cost of EEG in the acute ischemic stroke setting. Methods: We conducted a retrospective chart review of patients admitted to a single academic tertiary care center in the United States between September 1, 2015 to November 30, 2019 with a primary diagnosis of acute ischemic stroke and who were monitored on electroencephalography (EEG) for suspected seizures (total number of 70 patients). The primary outcome was how often EEG monitoring changed clinical management defined as starting, stopping, or changing the dose of an anti-epileptic drug. Secondary analysis was estimating the cost of EEG monitoring per change in management. Results: We identified 126 patients admitted with acute ischemic stroke who underwent EEG of which 70 met all inclusion and exclusion criteria. EEG monitoring resulted in a change in management in 22 patients (31%). Predictors associated with EEG monitoring resulting in a change in management were admission to the ICU, pre-existing atrial fibrillation, and symptomatic hemorrhagic transformation. Estimated cost of EEG per change in management was $1374.96 USD. Conclusion: EEG monitoring resulted in a changed management in nearly one-third of patients admitted with acute ischemic stroke suspected of having seizures.

Abstract 3994: Obese Patients Receiving Intravenous Thrombolysis in Acute Ischemic Stroke Have lower Rates of Intracerebral hemorrhage and Mortality

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ameer Hassan ◽  
Mikayel Grigoryan ◽  
Saqib Chaudhry ◽  
Adnan Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Intravenous Thrombolysis ◽  
International Classification Of Diseases ◽  
The United States ◽  
Obese Patients ◽  
Stroke Patients ◽  
Intravenous Tissue Plasminogen Activator ◽  
Classification Of Diseases

Background: The current recommended dose of intravenous tissue plasminogen activator (IV rt-PA) for ischemic stroke patients weighing >100 kg is fixed at 90 mg and thus obese patients receive less than the recommend 0.9mg/kg dosage. We hypothesized that obese patients receive a lower dose of thrombolytics and they will have a lower rates of intracerebral hemorrhages (ICH), but lower rates of clinical benefit from IV rt-PA. Objective: To determine the relationship between obesity and clinical outcomes among acute ischemic stroke patients receiving IV rt-PA. Methods: Data were obtained from all states within the United States that contributed to the Nationwide Inpatient Sample. All patients admitted to US hospitals between 2002 and 2009 with a primary discharge diagnosis of stroke treated with IV thrombolysis (identified by the International Classification of Diseases, Ninth Revision procedure codes) were included. We analyzed whether the presence of obesity was associated with clinical outcome and ICH with multivariate logistic regression analysis after adjusting for potential confounders. Results: Of the 84,727 patients with ischemic stroke treated with IV rt-PA, 5,437 (6.4%) had concurrent obesity. The ICH rates between obese and non-obese patients was 4.3% versus 6.1% (p=0.005). After adjusting for age, sex, hypertension, diabetes mellitus, renal failure, hospital teaching status, and ICH, the presence of obesity was not associated with increased rates of self-care (odds ratio [OR] 0.929, 95% confidence interval [CI] 0.815-1.063, p=0.27), but was associated with decreased rates of mortality (OR 0.78, 95% CI 0.61 - 0.94, p=0.045) at discharge. Conclusion: Obese patients undergoing IV t-PA treatment for acute ischemic stroke appear to have lower rates of ICHs and mortality presumably due to lower weight adjusted thrombolytic dose.

scholarly journals The Effect of Body Mass Index on Outcome after Endovascular Treatment in Acute Ischemic Stroke Patients: A Post Hoc Analysis of the MR CLEAN Trial

2019 ◽  
Vol 48 (3-6) ◽  
pp. 200-206 ◽  
Author(s):  
France Anne Victoire Pirson ◽  
Wouter H. Hinsenveld ◽  
Julie Staals ◽  
Bianca T.A. de Greef ◽  
Wim H. van Zwam ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Lower Risk ◽  
Normal Weight ◽  
Stroke Patients ◽  
Post Hoc Analysis ◽  
Post Hoc ◽  
The Impact

Background: Though obesity is a well-known risk factor for vascular disease, the impact of obesity on stroke outcome has been disputed. Several studies have shown that obesity is associated with better functional outcome after stroke. Whether obesity influences the benefit of endovascular treatment (EVT) in stroke patients is unknown. We evaluated the association between body mass index (BMI) and outcome in acute ischemic stroke patients with large vessel ­occlusion (LVO), and assessed whether BMI affects the ­benefit of EVT. Methods: This is a post hoc analysis of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands trial (­ISRCTN10888758). BMI was used as a continuous and categorical variable, distinguishing underweight and normal weight (BMI <25), overweight (BMI 25–30), and obesity (BMI ≥30). We used multivariable ordinal logistic regression analysis to estimate the association of BMI with functional outcome (shift analysis), assessed with modified Rankin Scale (mRs) at 90 days. The impact of BMI on EVT effect was tested by the use of a multiplicative interaction term. Results: Of 366 patients, 160 (44%) were underweight or normal weight, 145 (40%) overweight, and 61 (17%) were obese. In multivariable analysis with BMI as a continuous variable, we found a shift toward better functional outcome with higher BMI (mRS adjusted common OR 1.04; 95% CI 1.0–1.09), and mortality was inversely related to BMI (aOR 0.92; 95% CI 0.85–0.99). Safety analysis showed that higher BMI was associated with lower risk of stroke progression (aOR 0.92, 95% CI 0.87–0.99). Additional analysis showed no interaction between BMI and EVT effect on functional outcome, mortality, and other safety outcomes. Conclusion: Our study confirms the effect of obesity on outcome in acute ischemic stroke patients with LVO, meaning better functional outcome, lower mortality, and lower risk of stroke progression for patients with higher BMI. As we found no interaction between BMI and EVT effect, all BMI classes may expect the same benefit from EVT.

Sign in / Sign up

Export Citation Format

Share Document