Clinical outcome of patients with mild pre-stroke morbidity following endovascular treatment: a HERMES substudy
Por:
McDonough, RV, Ospel, JM, Majoie, CBLM, Saver, JL, White, P, Dippel, DWJ, Brown, SB, Demchuk, AM, Jovin, TG, Mitchell, PJ, Bracard, S, Campbell, BCV, Muir, KW, Hill, MD, Guillemin, F, Goyal, M, HERMES Collaborators
Publicada:
1 mar 2023
Ahead of Print:
1 feb 2022
Resumen:
Background Analyses of the effect of pre-stroke functional levels on the outcome of endovascular therapy (EVT) have focused on the course of patients with moderate to substantial pre-stroke disability. The effect of complete freedom from pre-existing disability (modified Rankin Scale (mRS) 0) versus predominantly mild pre-existing disability/symptoms (mRS 1-2) has not been well delineated. Methods The HERMES meta-analysis pooled data from seven randomized trials that tested the efficacy of EVT. We tested for a multiplicative interaction effect of pre-stroke mRS on the relationship between treatment and outcomes. Ordinal regression was used to assess the association between EVT and 90-day mRS (primary outcome) in the subgroup of patients with pre-stroke mRS 1-2. Multivariable regression modeling was then used to test the effect of mild pre-stroke disability/symptoms on the primary and secondary outcomes (delta-mRS, mRS 0-2/5-6) compared with patients with pre-stroke mRS 0. Results We included 1764 patients, of whom 199 (11.3%) had pre-stroke mRS 1-2. No interaction effect of pre-stroke mRS on the relationship between treatment and outcome was observed. Patients with pre-stroke mRS 1-2 had worse outcomes than those with pre-stroke mRS 0 (adjusted common OR (acOR) 0.53, 95% CI 0.40 to 0.70). Nonetheless, a significant benefit of EVT was observed within the mRS 1-2 subgroup (cOR 2.08, 95% CI 1.22 to 3.55). Conclusions Patients asymptomatic/without disability prior to onset have better outcomes following EVT than patients with mild disability/symptoms. Patients with pre-stroke mRS 1-2, however, more often achieve good outcomes with EVT compared with conservative management. These findings indicate that mild pre-existing disability/symptoms influence patient prognosis after EVT but do not diminish the EVT treatment effect.
Filiaciones:
McDonough, RV:
Univ Med Ctr Hamburg Eppendorf, Diagnost & Intervent Neuroradiol, Hamburg, Germany
Univ Calgary, Radiol, Calgary, AB, Canada
Ospel, JM:
Univ Hosp Basel, Neuroradiol, Basel, Switzerland
Majoie, CBLM:
Univ Amsterdam, Amsterdam UMC, Radiol & Nucl Med, Amsterdam, Netherlands
Saver, JL:
Univ Calif Los Angeles, David Geffen Sch Med, Neurol, Los Angeles, CA 90095 USA
White, P:
Newcastle Univ, Inst Neurosci, Newcastle Upon Tyne, Tyne & Wear, England
Dippel, DWJ:
Erasmus MC, Neurol, Rotterdam, Netherlands
Brown, SB:
BRIGHT Res Partners, Mooresville, NC USA
Demchuk, AM:
Univ Calgary, Clin Neurosci, Calgary, AB, Canada
Jovin, TG:
Cooper Univ Hosp, Neurol, Camden, NJ USA
Mitchell, PJ:
Royal Melbourne Hosp, Radiol, Parkville, Vic, Australia
Bracard, S:
Univ Lorraine, Neuroradiol, Nancy, France
Campbell, BCV:
Univ Melbourne, Med, Parkville, Vic, Australia
Royal Melbourne Hosp, Neurol, Melbourne, Vic, Australia
Muir, KW:
Queen Elizabeth Univ Hosp, Inst Neurosci & Psychol, Glasgow, Lanark, Scotland
Hill, MD:
Univ Calgary, Clin Neurosci, Calgary, AB, Canada
Guillemin, F:
Univ Hosp Ctr Nancy, Dept Clin Epidemiol, Nancy, France
Goyal, M:
Univ Calgary, Radiol, Calgary, AB, Canada
Martí-Fàbregas J.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Green Published
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