Mehdi Bouslama, Leticia C Rebello, Diogo C Haussen, Jonathan A Grossberg, Aaron M Anderson, Samir R Belagaje, Nicolas A Bianchi, Michael R Frankel, Raul G Nogueira
{"title":"血管内治疗与脑卒中预后的种族差异。","authors":"Mehdi Bouslama, Leticia C Rebello, Diogo C Haussen, Jonathan A Grossberg, Aaron M Anderson, Samir R Belagaje, Nicolas A Bianchi, Michael R Frankel, Raul G Nogueira","doi":"10.1159/000487607","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and purpose: </strong>Ethnic disparities in stroke are well described, with a higher incidence of disability and increased mortality in Blacks versus Whites. We sought to compare the clinical outcomes between those ethnic groups after stroke endovascular therapy (ET).</p><p><strong>Methods: </strong>We performed a retrospective review of the prospectively acquired Grady Endovascular Stroke Outcomes Registry between September 1, 2010 and September 30, 2015. Patients were dichotomized into two groups - Caucasians and African-Americans - and matched for age, pretreatment glucose level, and baseline National Institutes of Health Stroke Scale (NIHSS) score. Baseline characteristics as well as procedural and outcome parameters were compared.</p><p><strong>Results: </strong>Out of the 830 patients treated with ET, 308 pairs of patients (<i>n</i> = 616) underwent primary analysis. African-Americans were younger (<i>p</i> < 0.01), had a higher prevalence of hypertension (<i>p</i> < 0.01) and diabetes (<i>p</i> = 0.04), and had higher Alberta Stroke Program Early CT Score values (<i>p</i> = 0.03) and shorter times to treatment (<i>p</i> = 0.01). Blacks more frequently had Medicaid coverage and less private insurance (29.6 vs. 11.4% and 41.5 vs. 60.3%, respectively, <i>p</i> < 0.01). The remaining baseline characteristics, including baseline NIHSS score and CT perfusion-derived ischemic core volumes, were well balanced. There were no differences in the overall distribution of 90-day modified Rankin scale scores (<i>p</i> = 0.28), rates of successful reperfusion (84.7 vs. 85.7%, <i>p</i> = 0.91), good outcomes (49.1 vs. 44%, <i>p</i> = 0.24), or parenchymal hematomas (6.5 vs. 6.8%, <i>p</i> = 1.00). Blacks had lower 90-day mortality rates (18 vs. 24.6%, <i>p</i> = 0.04) in univariate analysis, which persisted as a nonsignificant trend after adjustment for potential confounders (OR 0.52, 95% CI 0.26-1.03, <i>p</i> = 0.06).</p><p><strong>Conclusions: </strong>Despite unique baseline characteristics, African-Americans treated with ET for large vessel occlusion strokes have similar outcomes as Caucasians. Greater availability of ET may diminish the ethnic/racial disparities in stroke outcomes.</p>","PeriodicalId":46280,"journal":{"name":"Interventional Neurology","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000487607","citationCount":"8","resultStr":"{\"title\":\"Endovascular Therapy and Ethnic Disparities in Stroke Outcomes.\",\"authors\":\"Mehdi Bouslama, Leticia C Rebello, Diogo C Haussen, Jonathan A Grossberg, Aaron M Anderson, Samir R Belagaje, Nicolas A Bianchi, Michael R Frankel, Raul G Nogueira\",\"doi\":\"10.1159/000487607\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and purpose: </strong>Ethnic disparities in stroke are well described, with a higher incidence of disability and increased mortality in Blacks versus Whites. We sought to compare the clinical outcomes between those ethnic groups after stroke endovascular therapy (ET).</p><p><strong>Methods: </strong>We performed a retrospective review of the prospectively acquired Grady Endovascular Stroke Outcomes Registry between September 1, 2010 and September 30, 2015. Patients were dichotomized into two groups - Caucasians and African-Americans - and matched for age, pretreatment glucose level, and baseline National Institutes of Health Stroke Scale (NIHSS) score. Baseline characteristics as well as procedural and outcome parameters were compared.</p><p><strong>Results: </strong>Out of the 830 patients treated with ET, 308 pairs of patients (<i>n</i> = 616) underwent primary analysis. African-Americans were younger (<i>p</i> < 0.01), had a higher prevalence of hypertension (<i>p</i> < 0.01) and diabetes (<i>p</i> = 0.04), and had higher Alberta Stroke Program Early CT Score values (<i>p</i> = 0.03) and shorter times to treatment (<i>p</i> = 0.01). Blacks more frequently had Medicaid coverage and less private insurance (29.6 vs. 11.4% and 41.5 vs. 60.3%, respectively, <i>p</i> < 0.01). The remaining baseline characteristics, including baseline NIHSS score and CT perfusion-derived ischemic core volumes, were well balanced. There were no differences in the overall distribution of 90-day modified Rankin scale scores (<i>p</i> = 0.28), rates of successful reperfusion (84.7 vs. 85.7%, <i>p</i> = 0.91), good outcomes (49.1 vs. 44%, <i>p</i> = 0.24), or parenchymal hematomas (6.5 vs. 6.8%, <i>p</i> = 1.00). Blacks had lower 90-day mortality rates (18 vs. 24.6%, <i>p</i> = 0.04) in univariate analysis, which persisted as a nonsignificant trend after adjustment for potential confounders (OR 0.52, 95% CI 0.26-1.03, <i>p</i> = 0.06).</p><p><strong>Conclusions: </strong>Despite unique baseline characteristics, African-Americans treated with ET for large vessel occlusion strokes have similar outcomes as Caucasians. Greater availability of ET may diminish the ethnic/racial disparities in stroke outcomes.</p>\",\"PeriodicalId\":46280,\"journal\":{\"name\":\"Interventional Neurology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2018-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1159/000487607\",\"citationCount\":\"8\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Interventional Neurology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1159/000487607\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2018/6/19 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Interventional Neurology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000487607","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2018/6/19 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}
Endovascular Therapy and Ethnic Disparities in Stroke Outcomes.
Background and purpose: Ethnic disparities in stroke are well described, with a higher incidence of disability and increased mortality in Blacks versus Whites. We sought to compare the clinical outcomes between those ethnic groups after stroke endovascular therapy (ET).
Methods: We performed a retrospective review of the prospectively acquired Grady Endovascular Stroke Outcomes Registry between September 1, 2010 and September 30, 2015. Patients were dichotomized into two groups - Caucasians and African-Americans - and matched for age, pretreatment glucose level, and baseline National Institutes of Health Stroke Scale (NIHSS) score. Baseline characteristics as well as procedural and outcome parameters were compared.
Results: Out of the 830 patients treated with ET, 308 pairs of patients (n = 616) underwent primary analysis. African-Americans were younger (p < 0.01), had a higher prevalence of hypertension (p < 0.01) and diabetes (p = 0.04), and had higher Alberta Stroke Program Early CT Score values (p = 0.03) and shorter times to treatment (p = 0.01). Blacks more frequently had Medicaid coverage and less private insurance (29.6 vs. 11.4% and 41.5 vs. 60.3%, respectively, p < 0.01). The remaining baseline characteristics, including baseline NIHSS score and CT perfusion-derived ischemic core volumes, were well balanced. There were no differences in the overall distribution of 90-day modified Rankin scale scores (p = 0.28), rates of successful reperfusion (84.7 vs. 85.7%, p = 0.91), good outcomes (49.1 vs. 44%, p = 0.24), or parenchymal hematomas (6.5 vs. 6.8%, p = 1.00). Blacks had lower 90-day mortality rates (18 vs. 24.6%, p = 0.04) in univariate analysis, which persisted as a nonsignificant trend after adjustment for potential confounders (OR 0.52, 95% CI 0.26-1.03, p = 0.06).
Conclusions: Despite unique baseline characteristics, African-Americans treated with ET for large vessel occlusion strokes have similar outcomes as Caucasians. Greater availability of ET may diminish the ethnic/racial disparities in stroke outcomes.
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