In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
Abstract:
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.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.55.suppl_1.60
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2024
detail.hit.zdb_id:
1467823-8
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