Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry
Por:
Rudilosso, S, Rios, J, Rodriguez, A, Gomis, M, Vera, V, Gomez-Choco, M, Renu, A, Matos, N, Llull, L, Purroy, F, Amaro, S, Terceno, M, Obach, V, Serena, J, Marti-Fabregas, J, Cardona, P, Molina, C, Rodriguez-Campello, A, Canovas, D, Krupinski, J, Ustrell, X, Torres, F, San Roman, L, Salvat-Plana, M, Jimenez-Fabrega, FX, Palomeras, E, Catena, E, Colom, C, Cocho, D, Baiges, J, Aragones, JM, Diaz, G, Costa, X, Almendros, MC, Rybyeba, M, Barcelo, M, Carrion, D, Lopez, MN, Sanjurjo, E, de la Ossa, NP, Urra, X, Chamorro, A
Publicada:
1 sep 2021
Resumen:
Background and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score <= 2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score <6, proximal vertebrobasilar occlusion, supratherapeutic international normalized ratio >3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups' criteria). Results Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). Conclusions Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.
Filiaciones:
Rudilosso, S:
Hosp Clin Barcelona, Dept Neurosci, Comprehens Stroke Ctr, 170 Villarroel, Barcelona 08036, Spain
August Pi & Sunyer Biomed Res Inst IDIBAPS, Cerebrovasc Dis, Clin & Expt Neurosci, Barcelona, Spain
Rios, J:
August Pi & Sunyer Biomed Res Inst IDIBAPS, Med Stat Core Facil, Barcelona, Spain
Hosp Clin Barcelona, Barcelona, Spain
Autonomous Univ Barcelona, Fac Med, Biostat Unit, Barcelona, Spain
Rodriguez, A:
Hosp Clin Barcelona, Dept Neurosci, Comprehens Stroke Ctr, 170 Villarroel, Barcelona 08036, Spain
Gomis, M:
Germans Trias Hosp, Stroke Unit, Dept Neurosci, Badalona, Spain
Vera, V:
Hosp Clin Barcelona, Dept Neurosci, Comprehens Stroke Ctr, 170 Villarroel, Barcelona 08036, Spain
Gomez-Choco, M:
Moises Broggi Hosp, Dept Neurol, St Joan Despi, Spain
Renu, A:
Hosp Clin Barcelona, Dept Neurosci, Comprehens Stroke Ctr, 170 Villarroel, Barcelona 08036, Spain
August Pi & Sunyer Biomed Res Inst IDIBAPS, Cerebrovasc Dis, Clin & Expt Neurosci, Barcelona, Spain
Matos, N:
Althaia Fdn Hosp, Dept Neurol, Manresa, Spain
Llull, L:
Hosp Clin Barcelona, Dept Neurosci, Comprehens Stroke Ctr, 170 Villarroel, Barcelona 08036, Spain
August Pi & Sunyer Biomed Res Inst IDIBAPS, Cerebrovasc Dis, Clin & Expt Neurosci, Barcelona, Spain
Purroy, F:
Univ Hosp Arnau Vilanova, Dept Neurol, Stroke Unit, Lleida, Spain
Amaro, S:
Hosp Clin Barcelona, Dept Neurosci, Comprehens Stroke Ctr, 170 Villarroel, Barcelona 08036, Spain
August Pi & Sunyer Biomed Res Inst IDIBAPS, Cerebrovasc Dis, Clin & Expt Neurosci, Barcelona, Spain
Terceno, M:
Josep Trueta Univ Hosp, Dept Neurol, Stroke Unit, Girona, Spain
Obach, V:
Hosp Clin Barcelona, Dept Neurosci, Comprehens Stroke Ctr, 170 Villarroel, Barcelona 08036, Spain
Serena, J:
Josep Trueta Univ Hosp, Dept Neurol, Stroke Unit, Girona, Spain
Marti-Fabregas, J:
Santa Creu & St Pau, Dept Neurol, Stroke Unit, Barcelona, Spain
Cardona, P:
Bellvitge Univ Hosp, Dept Neurol, Stroke Unit, Barcelona, Spain
Molina, C:
Vall Hebron Univ Hosp, Dept Neurol, Stroke Unit, Barcelona, Spain
Rodriguez-Campello, A:
Hosp del Mar, Dept Neurol, Stroke Unit, Barcelona, Spain
Canovas, D:
Parc Tauli Hosp, Dept Neurol, Sabadell, Spain
Krupinski, J:
Mutua de Terrassa Univ Hosp, Dept Neurol, Terrassa, Spain
Ustrell, X:
Joan XXIII Univ Hosp, Dept Neurol, Stroke Unit, Terragona, Spain
Torres, F:
August Pi & Sunyer Biomed Res Inst IDIBAPS, Med Stat Core Facil, Barcelona, Spain
Hosp Clin Barcelona, Barcelona, Spain
Autonomous Univ Barcelona, Fac Med, Biostat Unit, Barcelona, Spain
San Roman, L:
Hosp Clin Barcelona, Dept Radiol, Barcelona, Spain
Salvat-Plana, M:
Pla Director Malaltia Vasc Cerebral Catalan Strok, Dept Hlth, Barcelona, Spain
Jimenez-Fabrega, FX:
Emergency Med Serv Catalonia, Barcelona, Spain
Palomeras, E:
Hosp Mataro, Dept Neurol, Mataro, Spain
Catena, E:
Consorci Sanitari Garraf Hosp, Dept Neurol, St Pere De Ribes, Spain
Colom, C:
Hosp Igualada, Dept Emergency, Igualada, Spain
Cocho, D:
Hosp Granollers, Dept Emergency, Granollers, Spain
Baiges, J:
Verge De La Cinta Hosp, Dept Emergency, Tortosa, Spain
Aragones, JM:
Vic Univ Hosp, Dept Emergency, Vic, Spain
Diaz, G:
Hosp Campdevanol, Dept Emergency, Campdevanol, Spain
Costa, X:
Hosp Figueres, Dept Emergency, Figueres, Spain
Almendros, MC:
Hosp Palamos, Dept Emergency, Palamos, Spain
Rybyeba, M:
Hosp Olot, Dept Emergency, Olot, Spain
Barcelo, M:
Cerdanya Hosp, Dept Emergency, Puigcerda, Spain
Carrion, D:
Hosp Mora Ebre, Dept Emergency, Mora Debre, Spain
Lopez, MN:
Seu Urgell Hosp, Dept Emergency, Seu Durgell, Spain
Sanjurjo, E:
Hosp Tremp, Dept Emergency, Tremp, Spain
de la Ossa, NP:
Germans Trias Hosp, Stroke Unit, Dept Neurosci, Badalona, Spain
Pla Director Malaltia Vasc Cerebral Catalan Strok, Dept Hlth, Barcelona, Spain
Urra, X:
Hosp Clin Barcelona, Dept Neurosci, Comprehens Stroke Ctr, 170 Villarroel, Barcelona 08036, Spain
August Pi & Sunyer Biomed Res Inst IDIBAPS, Cerebrovasc Dis, Clin & Expt Neurosci, Barcelona, Spain
Chamorro, A:
Hosp Clin Barcelona, Dept Neurosci, Comprehens Stroke Ctr, 170 Villarroel, Barcelona 08036, Spain
August Pi & Sunyer Biomed Res Inst IDIBAPS, Cerebrovasc Dis, Clin & Expt Neurosci, Barcelona, Spain
Univ Barcelona, Barcelona, Spain
Green Published, gold
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