Introduction Prediction of outcome following endovascular thrombectomy in acute stroke is mostly related with the extent of ischemic injury and time treatment window. We were interested in understanding race/ethnicity-related differences in outcome of acute stroke patients who received endovascular thrombectomy with respect to variance in admission demographics and comorbidities during the acute hospitalization phase using the Premier database. Previous studies reported that black patients had significantly lower rates of overall endovascular thrombectomy utilization in the U.S. However, race/ethnicity related outcome in endovascular thrombectomy has not been reported previously.
Methods We utilized the Premier data (2011 to 2015) including 4,763 adults (age ≤18) with acute stroke who received endovascular thrombectomy using ICD-9 procedure and chronic/acute comorbidity using ICD-9 diagnostic code for as well as demographic profiles based on administration data. We analyzed outcomes using the patients’ ethnicity as independent variables to evaluate racial disparity in endovascular thrombectomy. We identified variables for (1) comorbidities; hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, congestive heart failure, atrial fibrillation/flutter COPD, tobacco/alcohol dependence and morbid obesity, (2) Socio-economic status; age, sex and races/ethnicities were categorized as binary variables as white versus non-white and black versus non-black and hispanic versus non-hispanic. Chi-square analysis used for binary independent factor race variables. Race variables categorized as (1) white, (2) black, and (3) others. The Bonferroni correction was applied to compare means among groups. We compared in-hospital outcome including mortality, post-operative stroke and functional outcome using discharge disposition; home versus transferred to other hospital or not adjusting acute and chronic comorbidity using multiple logistic regression (SAS 9.4).
Results The mean age for endovascular thrombectomy patients with acute stroke was 66.8 years (SD ± 15.4 years) with 58% > 65 years old; 51.2% females; 70.7% whites, 12.1% blacks, 0.2% hispanics and 17% others. Black and hispanic races received relatively low rate of endovascular thrombectomy utilization compared to white (p = 0.001). As comorbidities, 76.1% had HTN, 33.2% DM, 50.3% HLD, 28% CAD, 20.7% CHF, A fibrillation or flutter 44.9%, 2% COPD, 12.2% chronic renal failure, 10.5% acute renal failure, 18% tobacco dependence, 1.5% alcohol dependence, 4.2% morbid obesity, 2.3% Pneumonia, 5.0% Sepsis and 5.2% MI. As an outcome makers, in-patient mortality 16.7% (white 16.8%, black 14.9%, hispanic 0% and others 17.6%), discharge to home 28.7% (white 28%, black 31.4%, hispanic 22.2% and others 30%) versus disposition to any facility 71.3% (white 72%, black 69.6%, hispanic 77.8% and others 70%), and post thrombectomy stroke was 6.3% (white 6.5%, black 5.4%, hispanic 0% and others 6.3%). Since number of hispanics is very small, we divided the cohort into three racial groups: white, black, and others. Multiple variables for chronic/acute comorbidities identified associated with outcomes. After adjustment using logistic regression, race was not associated with three in-hospital outcome variables: mortality (p = 0.183), post-operative stroke (p = 0.610) and discharge disposition (p = 0.231).
Conclusions There were no differences in hospital outcome among races/ethnicities in endovascular thrombectomy outcomes for acute stroke patients in the Premier data. Racial/ethnic disparities play role for patients’ selection not for patients’ outcome in endovascular thrombectomy.
Disclosures S. Park: None. M. Pilot: None. M. Alexander: 1; C; Consultant for Stryker Neurovascular, Medtronic, and Penumbra, Inc. A. Rosengart: None.
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