Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota.
Department of Cardiology, West Virginia University, Morgantown, West Virginia.
Catheter Cardiovasc Interv. 2021 Feb 15;97(3):470-474. doi: 10.1002/ccd.29385. Epub 2020 Nov 16.
We sought to evaluate the nationwide trends in the characteristics and outcomes of for endovascular stroke therapy in contemporary practice.
We selected patients with acute ischemic stroke who underwent endovascular stroke therapy between 01 October 2015 and 30 September 2019 in a large academic consortium database. The end points of this study were (a) in-hospital mortality and functional outcomes and, (b) predictors of poor functional outcome, defined as death or discharge to hospice, or to a long-term nursing facility.
Among the 22,193 included patients; 50.3% were females, and 66.5% were white. Mean age was 68±15 years. Poor functional outcomes occurred in 8,274 patients (37.4%), of whom 2,741 (12.4%) died in the hospital, 1,345 (6.1%) were discharged to hospice, and 4,188 (18.9%) were discharged to other long-term facilities. Most common in-hospital complications were mechanical ventilation (32.3%), intracranial hemorrhage (18.9%), and acute kidney injury (15.6%). Median total and intensive-care length-of-stay were 7 days (IQR = 4-9), and 2 days (IQR = 1-4), respectively. Median cost was $36,609 (IQR = $26,034-$54,313). In a multi-logistic regression analysis; age, hypertension, diabetes, anemia, heart failure, vascular disease, chronic pulmonary disease, renal insufficiency, Medicare/medicaid insurance, transfer from nonendovascular capable hospital, and low procedural volume independently predicted poor functional outcomes. Tissue plasminogen activator use was associated with better functional outcomes.
There is a substantial growth in the performance of endovascular stroke interventions in the United States in recent years, and those were associated with favorable short-term outcomes.
我们旨在评估在当代实践中接受血管内卒中治疗的患者的特征和结局的全国性趋势。
我们从一个大型学术联盟数据库中选择了在 2015 年 10 月 1 日至 2019 年 9 月 30 日期间接受血管内卒中治疗的急性缺血性卒中患者。本研究的终点为：（a）住院死亡率和功能结局，以及（b）不良功能结局的预测因素，定义为死亡或转至临终关怀、长期护理机构。
在纳入的 22193 例患者中，50.3%为女性，66.5%为白人。平均年龄为 68±15 岁。8274 例患者（37.4%）出现不良功能结局，其中 2741 例（12.4%）住院期间死亡，1345 例（6.1%）转至临终关怀，4188 例（18.9%）转至其他长期护理机构。最常见的院内并发症为机械通气（32.3%）、颅内出血（18.9%）和急性肾损伤（15.6%）。总住院时间和重症监护室住院时间中位数分别为 7 天（IQR=4-9）和 2 天（IQR=1-4）。中位费用为 36609 美元（IQR=26034-54313）。多因素逻辑回归分析显示，年龄、高血压、糖尿病、贫血、心力衰竭、血管疾病、慢性肺部疾病、肾功能不全、医疗保险/医疗补助保险、从非血管内治疗能力的医院转院以及低手术量独立预测不良功能结局。组织型纤溶酶原激活物的使用与更好的功能结局相关。
近年来，美国血管内卒中干预的开展有了实质性的增长，并且与良好的短期结局相关。
