Marianne Hahn, Sonja Gröschel, Livia Sophie Lang, Ahmed E Othman, Klaus Gröschel, Timo Uphaus
{"title":"Mortality within three months after nonfatal ischemic stroke treated by mechanical thrombectomy in routine care-data from the German Stroke Registry.","authors":"Marianne Hahn, Sonja Gröschel, Livia Sophie Lang, Ahmed E Othman, Klaus Gröschel, Timo Uphaus","doi":"10.1186/s42466-025-00427-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) is a highly effective treatment for large vessel occlusion (LVO) ischemic stroke. However, a substantial share of patients have lethal outcome within 3 months. Individualization of outcome prognostication is needed to support clinical decision-making throughout the care pathway after MT. We investigate predictors of lethal outcome in patients with nonfatal LVO, defined by discharge alive from primary treating hospital, in a large prospective registry study of MT under routine care conditions.</p><p><strong>Methods: </strong>6,518 patients with nonfatal LVO treated by MT enrolled in the German Stroke Registry-Endovascular Treatment from May 2015-December 2021 were analysed with regard to lethal outcome by 3 month follow-up. Univariate group comparisons and multiple logistic regression analysis were performed to identify patients with high odds for survival or lethal outcome.</p><p><strong>Results: </strong>We report 11.6% (757/6,518) 3 month mortality following hospital discharge after LVO treated by MT. Besides better functional outcome at discharge (modified Rankin scale < 4, odds ratio, OR [95% confidence interval, CI]: 2.38 [1.71-3.32], p < 0.001; National Institute of Health Stroke scale < 8, OR [95%CI]: 3.45 [2.55-4.66], p < 0.001), intravenous thrombolysis (OR [95%CI]: 1.48 [1.17-1.88], p = 0.001), successful recanalization (OR [95%CI]: 1.43 [1.08-1.90], p = 0.014) and discharge to a neurorehabilitative facility (versus nursing home: OR [95%CI]: 0.39 [0.26-0.58], p < 0.001; versus home: OR [95%CI]: 0.69 [0.49-0.97], p = 0.032) were independent predictors of survival. Predictors of lethal outcome were older age (OR [95%CI]: 1.09 [1.07-1.10], p < 0.001), male sex (OR [95%CI]: 1.24 [1.00-1.55], p = 0.049), premorbid disability (OR [95%CI]: 1.47 [1.08-2.02], p = 0.016), active smoking (OR [95%CI]: 1.51 [1.06-2.14], p = 0.023), anticoagulation therapy prior to LVO (OR [95%CI]: 1.45 [1.09-1.92], p = 0.010), stroke etiology, general anaesthesia during MT (OR [95%CI]: 1.31 [1.02-1.69], p = 0.035) and intracerebral haemorrhage (OR [95%CI]: 1.50 [1.13-1.99], p = 0.005).</p><p><strong>Conclusions: </strong>Lethal outcome after hospital discharge within 3 months after MT is frequent, accounting for more than one quarter of overall 3-month mortality after MT of LVO. Predictors of survival enable individual outcome prognostication, which assists clinical decision-making with regard to surveillance concerning complications, rehabilitative resource allocation and counselling about goals of care.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (Identifier: NCT03356392, Date of registration: 2017/11/22).</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"71"},"PeriodicalIF":3.2000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490031/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurological research and practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s42466-025-00427-7","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Mechanical thrombectomy (MT) is a highly effective treatment for large vessel occlusion (LVO) ischemic stroke. However, a substantial share of patients have lethal outcome within 3 months. Individualization of outcome prognostication is needed to support clinical decision-making throughout the care pathway after MT. We investigate predictors of lethal outcome in patients with nonfatal LVO, defined by discharge alive from primary treating hospital, in a large prospective registry study of MT under routine care conditions.
Methods: 6,518 patients with nonfatal LVO treated by MT enrolled in the German Stroke Registry-Endovascular Treatment from May 2015-December 2021 were analysed with regard to lethal outcome by 3 month follow-up. Univariate group comparisons and multiple logistic regression analysis were performed to identify patients with high odds for survival or lethal outcome.
Results: We report 11.6% (757/6,518) 3 month mortality following hospital discharge after LVO treated by MT. Besides better functional outcome at discharge (modified Rankin scale < 4, odds ratio, OR [95% confidence interval, CI]: 2.38 [1.71-3.32], p < 0.001; National Institute of Health Stroke scale < 8, OR [95%CI]: 3.45 [2.55-4.66], p < 0.001), intravenous thrombolysis (OR [95%CI]: 1.48 [1.17-1.88], p = 0.001), successful recanalization (OR [95%CI]: 1.43 [1.08-1.90], p = 0.014) and discharge to a neurorehabilitative facility (versus nursing home: OR [95%CI]: 0.39 [0.26-0.58], p < 0.001; versus home: OR [95%CI]: 0.69 [0.49-0.97], p = 0.032) were independent predictors of survival. Predictors of lethal outcome were older age (OR [95%CI]: 1.09 [1.07-1.10], p < 0.001), male sex (OR [95%CI]: 1.24 [1.00-1.55], p = 0.049), premorbid disability (OR [95%CI]: 1.47 [1.08-2.02], p = 0.016), active smoking (OR [95%CI]: 1.51 [1.06-2.14], p = 0.023), anticoagulation therapy prior to LVO (OR [95%CI]: 1.45 [1.09-1.92], p = 0.010), stroke etiology, general anaesthesia during MT (OR [95%CI]: 1.31 [1.02-1.69], p = 0.035) and intracerebral haemorrhage (OR [95%CI]: 1.50 [1.13-1.99], p = 0.005).
Conclusions: Lethal outcome after hospital discharge within 3 months after MT is frequent, accounting for more than one quarter of overall 3-month mortality after MT of LVO. Predictors of survival enable individual outcome prognostication, which assists clinical decision-making with regard to surveillance concerning complications, rehabilitative resource allocation and counselling about goals of care.
Trial registration: ClinicalTrials.gov (Identifier: NCT03356392, Date of registration: 2017/11/22).