Racial and Ethnic Disparities in Functional Outcome after Thrombectomy: A Cohort Study of an Integrated Stroke Network.
Racial and Ethnic Disparities in Functional Outcome after Thrombectomy: A Cohort Study of an Integrated Stroke Network.
复制标题
DOI：
10.1016/j.jstrokecerebrovasdis.2021.106131
复制
发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Zha A
中科院分区：
文献类型：
--
作者：
Jones E;Kumar A;Lopez-Rivera V;Sebaugh J;Kamal H;Sheth SA;Sharrief A;Zha A
先前的研究表明，缺血性卒中患者在获得治疗和结局方面存在种族差异。我们试图确定接受血管内血栓切除术（EVT）的缺血性卒中患者功能结局的种族差异。我们对2015年8月至2019年6月在1家综合性卒中中心和2家血栓切除术准备卒中中心前瞻性收集的卒中患者登记中的患者进行了回顾性审查。我们审查了接受机械血栓切除术的≥ 18岁患者，仅包括具有属于3个最大人种/种族组的人种/种族数据的患者：非西班牙裔白色（NHW）、非西班牙裔黑人（NHB）和西班牙裔（HIS）。我们比较了基线特征，并进行了多变量logistic回归，以评价良好功能结局的差异，良好功能结局定义为90天改良兰金评分（90天mRS 0-2）作为主要结局。次要结局为出院处置、住院时间和极佳功能结局（90天mRS 0-1）。结果以OR [95% CI]给出。在符合入选标准的666例患者中，45%为NHW，30%为NHB，19%为HIS。NHB和HIS患者比NHW年轻（平均年龄NHB 62岁; HIS 64岁; NHW 70岁; p<0.001）。糖尿病在NHB（32%，p=0.02）和HIS（47%，p<0.001）中的患病率高于NHW（23%）。发病前mRS、到达NIHSS、tPA治疗率无显著种族差异。NHW与其他人种组相比，按人种划分的主要结局无差异（OR 1.08 [0.68-1.72]），但与HIS患者相比，NHW发生次要结局（功能结局极佳）（aOR 2.23 [1.01-4.93]）（定义为mRS 0-1）的可能性更高。在这项超过600例接受EVT治疗的患者的研究中，我们没有发现功能结局的显著种族差异，除了HIS的功能结局不如NHW。需要进一步研究急性卒中后护理的差异。非标准缩写和首字母缩略词
Previous studies have shown racial disparities in access to treatment and outcomes in ischemic stroke patients. We sought to define racial disparities in functional outcomes among ischemic stroke patients receiving endovascular thrombectomy (EVT). We performed a retrospective review of patients in our institution’s prospectively collected stroke patient registry from 08/2015 to 06/2019 at 1 comprehensive and 2 thrombectomy-ready stroke centers. We reviewed patients aged ≥ 18 who received mechanical thrombectomy including only patients with race/ethnicity data belonging to the 3 largest race/ethnic groups: Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Hispanic (HIS). We compared baseline characteristics and performed multivariable logistic regression to evaluate differences in good functional outcome defined as 90-day modified Rankin score (90 day mRS 0–2) as the primary outcome. Secondary outcomes were discharge disposition, length of stay, and excellent functional outcome (90 day mRS 0–1). Results are given as OR [95% CI]. Among 666 patients that met inclusion criteria, 45% were NHW, 30% were NHB, and 19% were HIS. NHB and HIS patients were younger than NHW (average age NHB 62; HIS 64; and NHW 70; p<0.001). Diabetes was more prevalent in NHB (32%, p=0.02) and HIS (47%, p<0.001) compared to NHW (23%). There were no significant racial differences in pre-morbid mRS, arrival NIHSS, tPA treatment rates. There was no difference in primary outcome by race comparing NHW to the other racial groups (OR 1.08 [0.68–1.72]) but compared to HIS patients, NHW had a higher likelihood of the secondary outcome of excellent functional outcome (aOR 2.23 [1.01–4.93]) defined as mRS 0–1. In this study of over 600 patients treated with EVT, we did not find significant racial disparities in functional outcome except for less excellent functional outcome in HIS compared to NHW. Further study on disparities in post-acute stroke care is needed. Non-Standard Abbreviations and Acronyms