2012-2021 年单中心卒中取栓和溶栓治疗的十年趋势、差异及临床影响。
Ten-year trends, disparities, and clinical impact of stroke thrombectomy and thrombolysis: A single center experience 2012-2021.
机构信息
Northwell Health, New Hyde Park, NY, USA; Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset NY, USA; Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset NY, USA.
Northwell Health, New Hyde Park, NY, USA; Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset NY, USA; Imaging Clinical Effectiveness and Outcomes Research, Center for Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research, Manhasset, NY, USA.
出版信息
J Stroke Cerebrovasc Dis. 2024 Oct;33(10):107914. doi: 10.1016/j.jstrokecerebrovasdis.2024.107914. Epub 2024 Aug 2.
OBJECTIVES
As indications for acute ischemic stroke treatment expand, it is unclear whether disparities in treatment utilization and outcome still exist. The main objective of this study was to investigate disparities in acute ischemic stroke treatment and determine impact on outcome.
MATERIALS AND METHODS
Retrospective observational cohort study of consecutive ischemic stroke admissions to a comprehensive stroke center from 2012-2021 was performed. Primary exposure was intravenous thrombolysis and/or endovascular thrombectomy. Primary end points were discharge modified Rankin Scale, home disposition, and expired/hospice. Multivariable logistic regression analyses were conducted to elucidate disparities in treatment utilization and determine impact on outcome.
RESULTS
Of 517,615 inpatient visits, there were 7,540 (1.46 %) ischemic stroke admissions, increasing from 1.14 % to 1.79 % from 2012-2021. Intravenous thrombolysis significantly decreased from 14.4 % to 9.8 % while endovascular thrombectomy significantly increased from 0.8 % to 10.5 %. Both intravenous thrombolysis and endovascular thrombectomy increased odds of discharge home and modified Rankin Scale 0-2, and thrombectomy decreased odds of expired/hospice. After adjusting for covariates, decreased odds of thrombectomy was associated with Medicaid insurance (Odds Ratio [95 % Confidence Interval] 0.55 [0.32-0.93]), age 80+ (0.49 [0.35-0.69]), prior stroke (0.49 [0.31-0.77]), and diabetes mellitus (0.55 [0.39-0.79]), while low median household income (<$80,000/year) increased odds of no acute treatment (1.34 [1.16-1.56]). No sex or racial disparities were observed. Medicaid and low-income were not associated with worse clinical outcomes.
CONCLUSIONS
Less endovascular thrombectomy occurred in Medicaid, older, prior stroke, and diabetic patients, while low-income was associated with no treatment. The observed socioeconomic disparities did not impact discharge outcome.
目的
随着急性缺血性脑卒中治疗适应证的扩大，治疗利用和结局方面的差异是否仍然存在尚不清楚。本研究的主要目的是调查急性缺血性脑卒中治疗方面的差异，并确定其对结局的影响。
材料和方法
对 2012 年至 2021 年期间连续入住综合卒中中心的缺血性卒中住院患者进行回顾性观察性队列研究。主要暴露因素为静脉溶栓和/或血管内取栓。主要终点为出院时改良 Rankin 量表评分、出院去向和死亡/临终关怀。采用多变量逻辑回归分析来阐明治疗利用方面的差异，并确定其对结局的影响。
结果
在 517615 例住院患者中，有 7540 例（1.46%）为缺血性卒中入院患者，从 2012 年至 2021 年，这一比例从 1.14%增加到 1.79%。静脉溶栓的比例从 14.4%显著下降至 9.8%，而血管内取栓的比例从 0.8%显著增加至 10.5%。静脉溶栓和血管内取栓均增加了出院回家和改良 Rankin 量表 0-2 分的几率，而取栓降低了死亡/临终关怀的几率。在调整了协变量后，与接受取栓治疗相比，医疗保险（Medicaid）（优势比[95%置信区间]为 0.55[0.32-0.93]）、年龄 80 岁以上（0.49[0.35-0.69]）、既往卒中（0.49[0.31-0.77]）和糖尿病（0.55[0.39-0.79]）与取栓几率降低相关，而中等家庭收入（<$80000/年）增加了未接受急性治疗的几率（1.34[1.16-1.56]）。未观察到性别或种族差异。医疗保险和低收入与较差的临床结局无关。
结论
医疗保险、高龄、既往卒中、糖尿病患者的血管内取栓治疗较少，而低收入与未治疗相关。观察到的社会经济差异并未影响出院结局。
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