Temporal Trends in Racial and Ethnic Disparities in Endovascular Therapy in Acute Ischemic Stroke.
Temporal Trends in Racial and Ethnic Disparities in Endovascular Therapy in Acute Ischemic Stroke.
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DOI：
10.1161/jaha.121.023212
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发表时间：
2022-03-15
影响因子：
5.4
通讯作者：
Schwamm, Lee H.
中科院分区：
文献类型：
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作者：
Sheriff, Faheem;Xu, Haolin;Maud, Alberto;Gupta, Vikas;Vellipuram, Anantha;Fonarow, Gregg C.;Matsouaka, Roland A.;Xian, Ying;Reeves, Mathew;Smith, Eric E.;Saver, Jeffrey;Rodriguez, Gustavo;Cruz-Flores, Salvador;Schwamm, Lee H.
2015 年临床试验发表后，血管内治疗 (EVT) 的使用有所增加，但有限的数据表明可能存在持续的种族和民族差异。我们将 2012 年 4 月至 2019 年 6 月期间，在最后一次已知良好情况后 6 小时内到达且美国国立卫生研究院卒中量表 (NIHSS) 评分≥6 的所有急性缺血性卒中患者纳入 Get With TheGuidelines-Stroke 数据库，并评估了种族和族裔与 EVT 使用和结果之间的关联，比较了 2015 年之前和之后的时代。在 302965 名潜在合格患者中， 42 422 人 (14%) 接受了 EVT。尽管所有种族和民族群体中 EVT 的使用随着时间的推移而增加，但与非西班牙裔白人 (NHW) 患者相比，黑人患者使用 EVT 的几率降低（2015 年之前调整后的比值比 [aOR]，0.68 [0.58-0.78]；2015 年之后的 aOR，0.83 [0.76-0.90]）。与 NHW 相比，黑人、西班牙裔和亚洲患者的院内死亡/出院到临终关怀中心的频率较低。相反，与 NHW (24%) 相比，西班牙裔 (29.7%；aOR，1.28 [1.16-1.42])、亚洲人 (28.2%；aOR，1.23 [1.05-1.44]) 和黑人 (29.1%；aOR，1.08 [1.00-1.18]) 患者出院回家的频率更高。然而，在 3 个月时，与 NHW 患者 (38.1%) 相比，黑人 (37.5%；aOR，0.84 [0.75-0.95]) 和亚洲人 (33%；aOR，0.79 [0.65-0.98]) 患者的功能独立（改良 Rankin 量表，0-2）发生频率较低。在接受 EVT 治疗的一大群患者中，黑人与 NHW 患者在 EVT 使用方面的差异随着时间的推移而缩小，但仍然存在。在代表性不足的种族和族裔群体中，与出院相关的结果稍微有利一些； 3 个月的功能结果较差，但随着时间的推移，所有组均有所改善。
Endovascular therapy (EVT) use increased following clinical trials publication in 2015, but limited data suggest there may be persistent race and ethnicity differences. We included all patients with acute ischemic stroke arriving within 6 hours of last known well and with National Institute of Health Stroke Scale (NIHSS) score ≥6 between April 2012 and June 2019 in the Get With The Guidelines‐Stroke database and evaluated the association between race and ethnicity and EVT use and outcomes, comparing the era before versus after 2015. Of 302 965 potentially eligible patients; 42 422 (14%) underwent EVT. Although EVT use increased over time in all racial and ethnic groups, Black patients had reduced odds of EVT use compared with non‐Hispanic White (NHW) patients (adjusted odds ratio [aOR] before 2015, 0.68 [0.58‒0.78]; aOR after 2015, 0.83 [0.76‒0.90]). In‐hospital mortality/discharge to hospice was less frequent in Black, Hispanic, and Asian patients compared with NHW. Conversely discharge home was more frequent in Hispanic (29.7%; aOR, 1.28 [1.16‒1.42]), Asian (28.2%; aOR, 1.23 [1.05‒1.44]), and Black (29.1%; aOR, 1.08 [1.00‒1.18]) patients compared with NHW (24%). However, at 3 months, functional independence (modified Rankin Scale, 0–2) occurred less frequently in Black (37.5%; aOR, 0.84 [0.75‒0.95]) and Asian (33%; aOR, 0.79 [0.65‒0.98]) patients compared with NHW patients (38.1%). In a large cohort of patients treated with EVT, Black versus NHW patient disparities in EVT use have narrowed over time but still exist. Discharge related outcomes were slightly more favorable in racial and ethnic underrepresented groups; 3‐month functional outcomes were worse but improved across all groups with time.