World Neurosurg. 2021 Mar 20:S1878-8750(21)00443-5. doi: 10.1016/j.wneu.2021.03.073. Online ahead of print.
ABSTRACT
BACKGROUND: and purpose: AHA/ASA guidelines recommend endovascular stroke therapy (EST) with tissue plasminogen activator (rt-PA) for eligible patients in acute ischemic stroke (AIS). Using the National Inpatient Sample database, we evaluated trends in treatment with rt-PA and EST for AIS and their outcomes.
METHODS: This is a cross-sectional observational study of AIS admitted in US hospitals 2012-2016. Patients were grouped into those who received rt-PA alone, EST alone, and rtPA+EST. Survey statistical procedures were performed. Multivariable regression analysis with pairwise comparisons of each treatment group with no treatment group was performed for discharge outcomes.
RESULTS: The study included 2,290,520 AIS patients with mean age 70.46 years. Treatment rates increased from 2012 to 2016 for rt-PA by 7% per year (5.86% to 7.67%, odds ratio [OR]=1.07, 95% confidence interval [CI] 1.05-1.08); and EST by 38% per year (0.55% to 1.75%, OR=1.38, 95% CI 1.31-1.45); but not rt-PA+EST (0.54% to 0.57%, OR=1.04, 95% CI 0.99-1.08). Mean length of stay reduced from 2012 to 2016 for rt-PA (6.07 to 4.91days, p<0.0001), and rt-PA+EST (9.19 to 7.10days, p=0.0067) but not for EST (9.61 to 8.51days, p=0.5074). The odds of patients discharged home increased by 8%, 9% and 15% among patients who received rt-PA alone, EST alone and rt-PA+EST respectively, compared to no treatment group.
CONCLUSION: The utilization of rt-PA alone and EST alone increased but that of rt-PA+EST remained unchanged from 2012 to 2016 in NIS.
PMID:33757890 | DOI:10.1016/j.wneu.2021.03.073
