Hussein Haitham M, Saleem Muhammad A, Qureshi Adnan I
Regions Hospital Comprehensive Stroke Center, St Paul, Minnesota.
Regions Hospital Comprehensive Stroke Center, St Paul, Minnesota; Zeenat Qureshi Stroke Institute, St Cloud, Minnesota; Mercyhealth, Janesville, Wisconsin.
J Stroke Cerebrovasc Dis. 2018 Mar;27(3):677-681. doi: 10.1016/j.jstrokecerebrovasdis.2017.09.056. Epub 2017 Nov 3.
The study aims at examining the changes in endovascular procedures utilization after the publication of the clinical trials showing their benefit in patients with acute ischemic stroke (AIS).
Minnesota Hospital Association database from 137 member hospitals was used to calculate the statewide utilization rates for 2 periods: prior to (calendar year 2014) and after (calendar year 2015) the publication of multiple randomized clinical trials showing the efficacy of endovascular therapy. Patients were identified using International Classification of Disease, Clinical Modification, 9th revision (ICD-9) or ICD-10 codes (ICD-10 started October 2015). Utilization rates for endovascular treatment were calculated monthly, quarterly, and annually.
Of the 13,043 patients admitted with AIS, 434 patients (mean age 68.5 ± 15.5 years; 51.2% women) received endovascular treatment. The number of procedures increased from 194 in 2014 to 240 in 2015. Utilization rate was 3.4% in the first quarter of 2014, gradually declined to reach its lowest value (2.6%) the last quarter of 2014, then steadily increased to reach its peak (4%) in the last quarter of 2015. Procedures performed at comprehensive stroke centers increased from 52% of total procedures in 2014 to 57.5% in 2015, whereas those performed at primary stroke centers decreased from 22.6% to 19.5%. In 2015, fewer patients had hypertension (50.4% versus 60.3%; P = .039) and more patients had chronic kidney disease (28.3% versus 15.5%; P = .001) compared with 2014. Intracranial hemorrhage, mortality rate, and rate of home discharge were similar between the 2 years.
Utilization of endovascular procedures for treatment of AIS has been rapidly influenced by medical literature.
本研究旨在探讨在发表显示血管内治疗对急性缺血性卒中（AIS）患者有益的临床试验后，血管内治疗的使用情况变化。
利用明尼苏达医院协会137家成员医院的数据库，计算两个时期的全州使用率：多个随机临床试验发表血管内治疗疗效之前（2014年日历年）和之后（2015年日历年）。使用国际疾病分类临床修订第9版（ICD - 9）或ICD - 10编码（ICD - 10于2015年10月开始使用）识别患者。每月、每季度和每年计算血管内治疗的使用率。
在13043例AIS入院患者中，434例患者（平均年龄68.5±15.5岁；51.2%为女性）接受了血管内治疗。治疗例数从2014年的194例增加到2015年的240例。2014年第一季度使用率为3.4%，逐渐下降至2014年最后一个季度达到最低值（2.6%），然后稳步上升至2015年最后一个季度达到峰值（4%）。在综合卒中中心进行的治疗从2014年占总治疗例数的52%增加到2015年的57.5%，而在初级卒中中心进行的治疗从22.6%降至19.5%。与2014年相比，2015年高血压患者减少（50.4%对60.3%；P = 0.039），慢性肾病患者增多（28.3%对15.5%；P = 0.001）。两年间颅内出血、死亡率和出院回家率相似。
医学文献对血管内治疗AIS的使用产生了迅速影响。
