Dataset Information

Mortality following mechanical thrombectomy for ischemic stroke in patients with COVID-19.

ABSTRACT:

Objectives

Multiple prior studies have shown a relationship between COVID-19 and strokes; further, COVID-19 has been shown to influence both time-to-thrombectomy and overall thrombectomy rates. Using large-scale, recently released national data, we assessed the association between COVID-19 diagnosis and patient outcomes following mechanical thrombectomy.

Materials and methods

Patients in this study were identified from the 2020 National Inpatient Sample. All patients with arterial strokes undergoing mechanical thrombectomy were identified using ICD-10 coding criteria. Patients were further stratified by COVID diagnosis (positive vs. negative). Other covariates, including patient/hospital demographics, disease severity, and comorbidities were collected. Multivariable analysis was used to determine the independent effect of COVID-19 on in-hospital mortality and unfavorable discharge.

Results

5078 patients were identified in this study; 166 (3.3%) were COVID-19 positive. COVID-19 patients had a significantly higher mortality rate (30.1% vs. 12.4%, p < 0.001). When controlling for patient/hospital characteristics, APR-DRG disease severity, and Elixhauser Comorbidity Index, COVID-19 was an independent predictor of increased mortality (OR 1.13, p = 0.002). COVID-19 was not significantly related to discharge disposition (p = 0.480). Older age and increased APR-DRG disease severity were also correlated with increase morality.

Conclusions

Overall, this study indicates that COVID-19 is a predictor of mortality among mechanical thrombectomy. This finding is likely multifactorial but may be related to multisystem inflammation, hypercoagulability, and re-occlusion seen in COVID-19 patients. Further research would be needed to clarify these relationships.

SUBMITTER: Dallas J

PROVIDER: S-EPMC10156987 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Mortality following mechanical thrombectomy for ischemic stroke in patients with COVID-19.

Dallas Jonathan J Wenger Talia A TA Liu Kristie Q KQ Ding Li L Hopkins Benjamin S BS Attenello Frank J FJ Mack William J WJ

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 20230504 8

<h4>Objectives</h4>Multiple prior studies have shown a relationship between COVID-19 and strokes; further, COVID-19 has been shown to influence both time-to-thrombectomy and overall thrombectomy rates. Using large-scale, recently released national data, we assessed the association between COVID-19 diagnosis and patient outcomes following mechanical thrombectomy.<h4>Materials and methods</h4>Patients in this study were identified from the 2020 National Inpatient Sample. All patients with arterial ...[more]

PMID: 37172468

Similar Datasets

Project description:AimPost-stroke-delirium has been linked to worse outcome in patients with acute cerebrovascular disease; identification of individuals at risk may prevent delirium and thereby improve outcome. We investigate prognosis and factors associated with post-stroke-delirium in patients with large vessel occlusion (LVO) ischemic stroke treated by mechanical thrombectomy (MT).Methods747 patients (53.4% female) prospectively enrolled in the Gutenberg-Stroke-Study from May 2018-November 2022 were analyzed with regard to diagnosis of delirium. Group comparison of patient-, stroke- and treatment characteristics as well as computed tomography(CT)-imaging based parameters of cerebral atrophy (global cortical atrophy [GCA], posterior atrophy [Koedam], medial temporal lobe atrophy [MTA] scores) and white matter lesions (Fazekas score) was conducted. Independent predictors of delirium and the association of delirium with functional outcome at 90-day follow-up was investigated by multiple logistic regression analyses.ResultsWe report 8.2% of patients (61/747) developing delirium following MT of LVO. Independent predictors were older age (aOR[95%CI] per year: 1.034[1.005-1.065], p = 0.023), male sex (aOR[95%CI]: 2.173[1.182-3.994], p = 0.012), general anesthesia during MT (aOR[95%CI]: 2.455[1.385-4.352], p = 0.002), infectious complications (aOR[95%CI]: 1.845[1.031-3.305], p = 0.039), "other determined" etiology of stroke (aOR[95%CI]: 2.424[1.100-5.345], p = 0.028), and a MTA score exceeding age-specific cut-offs (aOR[95%CI]: 2.126[1.065-4.244], p = 0.033). Delirium was independently associated with worse functional outcome (aOR[95%CI]: 2.902[1.005-8.383], p = 0.049) at 90-day follow-up.ConclusionDelirium is independently associated with worse functional outcome after MT of LVO, stressing the importance of screening and preventive measures. Besides conventional risk factors, pathological MTA scores and use of general anesthesia during MT may be easy-to-apply criteria to identify individuals at risk of delirium and implement prevention strategies.

Project description:BackgroundAdvances in stroke treatment have greatly improved outcomes; however, disparities in access to treatment might increase. Achieving equitable access to stroke treatment is a health policy challenge, as rapid treatment is essential for positive outcomes. This ecological cross-sectional study aimed to determine the relationship between the disparities in spatial accessibility to mechanical thrombectomy (SAMT) and stroke mortality rates in Japan, hypothesizing that disparities in SAMT may increase the differences in stroke mortality between regions.MethodsWe used the average number of ischemic stroke (IS) deaths between 2020 and 2021 as the response variable; and SAMT, medical resources, and socioeconomic characteristics of each municipality as explanatory variables. A conditional autoregressive model was used to examine the association between the risk of stroke mortality and SAMT. The standardized mortality ratio (SMR) was mapped to understand the nationwide disparities in stroke mortality risk.ResultsThe median number of IS deaths was 17.5 persons per year in the municipalities (2020 to 2021). The study also found that municipalities with low SAMT were located in the northern part of Japan. The non-spatial regression model results indicated that poor accessibility, a small proportion of bachelor's degrees or higher, and a high proportion of workers in secondary industries were related to high IS mortality. Three models were evaluated using spatial analysis; Model 1 with accessibility indicators alone, Model 2 with medical resources added to Model 1, and Model 3 with socioeconomic characteristics added to Model 2. In Models 1 and 2, the population-weighted spatial accessibility index (PWSAI) showed a significant negative relationship with stroke mortality. However, this was not evident in Model 3. Mapping using Model 3 showed that the high-risk areas were predominantly located in northern Japan, excluding Hokkaido.ConclusionAccess to mechanical thrombectomy was estimated, and regional differences were observed. The relationship between accessibility and IS mortality is unknown; however, regardless of accessibility, municipalities with a high proportion of workers in secondary industries and a small proportion with bachelor's degrees or above are at risk of death from stroke.

Project description:BackgroundThe beneficial effects of endovascular treatment with new-generation mechanical thrombectomy devices compared with intravenous thrombolysis alone to treat acute large-artery ischemic stroke have been shown in randomized controlled trials (RCTs). This study aimed to estimate the cost utility of mechanical thrombectomy compared with the established standard of care.MethodsWe developed a Markov decision process analytic model to assess the cost-effectiveness of treatment with mechanical thrombectomy plus intravenous thrombolysis versus treatment with intravenous thrombolysis alone from the public payer perspective in Canada. We conducted comprehensive literature searches to populate model inputs. We estimated the efficacy of mechanical thrombectomy plus intravenous thrombolysis from a meta-analysis of 5 RCTs, and we used data from the Oxford Vascular Study to model long-term clinical outcomes. We calculated incremental cost-effectiveness ratios (ICER) using a 5-year time horizon.ResultsThe base case analysis showed the cost and effectiveness of treatment with mechanical thrombectomy plus intravenous thrombolysis to be $126 939 and 1.484 quality-adjusted life-years (QALYs), respectively, and the cost and effectiveness of treatment with intravenous thrombolysis alone to be $124 419 and 1.273 QALYs, respectively. The mechanical thrombectomy plus intravenous thrombolysis strategy was associated with an ICER of $11 990 per QALY gained. Probabilistic sensitivity analysis showed that the probability of treatment with mechanical thrombectomy plus intravenous thrombolysis being cost-effective was 57.5%, 89.7% and 99.6% at thresholds of $20 000, $50 000 and $100 000 per QALY gained, respectively. The main factors influencing the ICER were time horizon, extra cost of mechanical thrombectomy treatment and age of the patient.InterpretationMechanical thrombectomy as an adjunct therapy to intravenous thrombolysis is cost-effective compared with treatment with intravenous thrombolysis alone for patients with acute large-artery ischemic stroke.

Dataset Information

Mortality following mechanical thrombectomy for ischemic stroke in patients with COVID-19.

Objectives

Materials and methods

Results

Conclusions

Publications

Mortality following mechanical thrombectomy for ischemic stroke in patients with COVID-19.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets