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Title: | Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry |
Author: | Rudilosso, Salvatore Ríos, José Rodríguez, Alejandro Gomis, Meritxell Vera, Víctor Gómez Choco, Manuel Renú, Arturo Matos, Núria Llull, Laura Purroy, Francisco Amaro, Sergio Terceño, Mikel Obach, Víctor Serena, Joaquim Martí Fàbregas, Joan Cardona, Pedro Molina, Carlos Rodríguez Campello, Ana Cánovas Vergé, David Krupinski, Jerzy Ustrell, Xavier Torres, Ferran San Román, Luis Salvat Plana, Mercè Jiménez Fàbrega, Francesc Xavier Palomeras, Ernest Catena, Esther Colom, Carla Cocho, Dolores Baiges, Juanjo Aragones, Josep Maria Diaz, Gloria Costa, Xavier Almendros, María Cruz Rybyeba, Maria Barceló, Miquel Carrión, Dolors Lòpez, Matilde Núria Sanjurjo, Eduard Ossa, Natalia Pérez de la Urra, Xabier Chamorro, Ángel Catalan Stroke Code And Reperfusion (CAT-SCR) Consortium |
Keywords: | Cirurgia cerebral Malalties cerebrovasculars Cerebral surgery Cerebrovascular disease |
Issue Date: | 30-Sep-2021 |
Publisher: | Korean Stroke Society |
Abstract: | 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. |
Note: | Reproducció del document publicat a: https://doi.org/10.5853/jos.2021.00962 |
It is part of: | Journal of Stroke, 2021, vol. 23, num. 3, p. 401-410 |
URI: | http://hdl.handle.net/2445/180763 |
Related resource: | https://doi.org/10.5853/jos.2021.00962 |
ISSN: | 2287-6405 |
Appears in Collections: | Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
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