SESSION TYPE: Neuro Critical Care
PRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM - 05:45 PM
PURPOSE: Ethnicity and gender have been shown previously to be associated with poor outcomes among ischemic stroke patients who undergo revascularization interventions(RIs). Our study evaluated the predictors of poor outcomes at a certified stroke center that serves inner-city minority New-Yorkers.
METHODS: All ischemic-stroke patients between 2006-2011 who received RIs were prospectively analyzed. IV-tPa was provided to all eligible patents during the 5-year-period while IA-tPA/mechanical-thrombectomy was available after August-2009. Door to needle time, BMI, age, sex, NIHSS(pre/discharge), eligibility/contraindications for RIs, discharge-disposition and overall mortality were recorded. Using logistic regression, odds ratios was calculated and 95%CI’s reported. P-value < 0.05 was considered significant.
RESULTS: 628/1411(44.5%) patients who presented within the therapeutic window were screened for eligibility, of these 112/628(17.8%) patients received RIs. This represented 97.8% of all patients who were eligible for RIs. 78 patients received IV-tPA alone, 17 IA-tPA and/or mechanical-thrombectomy and 17 a combination of all. 67(59.8%) were females, 40(35.7%) were African-American and 72(64.2%) Hispanics. The average age was 62.4years, and average BMI was 29.5. Average door to needle time was 51minutes, Pre-RI NIHSS was 13.2 and at discharge was 6.16. Of the 112 patients, 9(8%) expired, 19(17%) were discharged to nursing home and 84(75%) to an acute rehabilitation or to home. None of the demographic/ clinical variables including gender, ethnicity , BMI, door to needle time or pre-RI NIHSS predicted mortality in patients with acute-stroke(p=NS). When a composite endpoint of death/discharge to nursing home was analyzed, older age (OR1.06, 95%CI 1.01-1.1,p=0.010) was associated with significantly poorer outcomes. Comparing patients with NIHSS on admission of > 10 versus < 10, older-age(OR1.04,95%CI:1.01-1.07,p=0.016), and greater composite of poor outcomes(OR4.87,95%CI:1.36-17.5,p=0.015) were noted among those with NIHSS>10 on admission.
CONCLUSIONS: Compared to previous reports, our study did not find gender, ethnicity or BMI as predictors of mortality among ischemic-stroke patients who received RIs.
CLINICAL IMPLICATIONS: However, patients who died or were discharged to a nursing home had greater odds of advanced age and presented with severe strokes with NIHSS>10 on admission.
DISCLOSURE: The following authors have nothing to disclose: Paola Casanova, Neha Garg, Teresita Victor, Sundeep Mangla, Balaventakesh Balaventakesh, Melissa Schori, Raghu Loganathan
No Product/Research Disclosure InformationLincoln Medical & Mental Health Center, Pomona, NY