Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry

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. Me...

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Autores: Rudilosso, S, Rios, J, Rodriguez, A, Gomis, M, Vera, V, Gomez-Choco, M, Renu, A, Matos, N, Llull, L, Purroy, F, Amaro, S, Terceno, M, Obach, V, Serena, J, Marti-Fabregas, J, Cardona, P, Molina, C, Rodriguez-Campello, A, Canovas, D, Krupinski, J, Ustrell, X, Torres, F, San Roman, L, Salvat-Plana, M, Jimenez-Fabrega, FX, Palomeras, E, Catena, E, Colom, C, Cocho, D, Baiges, J, Aragones, JM, Diaz, G, Costa, X, Almendros, MC, Rybyeba, M, Barcelo, M, Carrion, D, Lopez, MN, Sanjurjo, E, de la Ossa, NP, Urra, X, Chamorro, A
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p5224
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5224
Access Level:acceso abierto
Palabra clave:Thrombectomy
Stroke
Prognosis
Outcome
Registries
Propensity score
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spelling Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based RegistryRudilosso, SRios, JRodriguez, AGomis, MVera, VGomez-Choco, MRenu, AMatos, NLlull, LPurroy, FAmaro, STerceno, MObach, VSerena, JMarti-Fabregas, JCardona, PMolina, CRodriguez-Campello, ACanovas, DKrupinski, JUstrell, XTorres, FSan Roman, LSalvat-Plana, MJimenez-Fabrega, FXPalomeras, ECatena, EColom, CCocho, DBaiges, JAragones, JMDiaz, GCosta, XAlmendros, MCRybyeba, MBarcelo, MCarrion, DLopez, MNSanjurjo, Ede la Ossa, NPUrra, XChamorro, AThrombectomyStrokePrognosisOutcomeRegistriesPropensity scoreBackground 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.KOREAN STROKE SOC2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5224Journal of StrokeISSN: 22876391ISSNe: 22876405reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p52242026-06-14T12:41:47Z
dc.title.none.fl_str_mv Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry
title Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry
spellingShingle Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry
Rudilosso, S
Thrombectomy
Stroke
Prognosis
Outcome
Registries
Propensity score
title_short Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry
title_full Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry
title_fullStr Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry
title_full_unstemmed Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry
title_sort Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry
dc.creator.none.fl_str_mv Rudilosso, S
Rios, J
Rodriguez, A
Gomis, M
Vera, V
Gomez-Choco, M
Renu, A
Matos, N
Llull, L
Purroy, F
Amaro, S
Terceno, M
Obach, V
Serena, J
Marti-Fabregas, J
Cardona, P
Molina, C
Rodriguez-Campello, A
Canovas, D
Krupinski, J
Ustrell, X
Torres, F
San Roman, L
Salvat-Plana, M
Jimenez-Fabrega, FX
Palomeras, E
Catena, E
Colom, C
Cocho, D
Baiges, J
Aragones, JM
Diaz, G
Costa, X
Almendros, MC
Rybyeba, M
Barcelo, M
Carrion, D
Lopez, MN
Sanjurjo, E
de la Ossa, NP
Urra, X
Chamorro, A
author Rudilosso, S
author_facet Rudilosso, S
Rios, J
Rodriguez, A
Gomis, M
Vera, V
Gomez-Choco, M
Renu, A
Matos, N
Llull, L
Purroy, F
Amaro, S
Terceno, M
Obach, V
Serena, J
Marti-Fabregas, J
Cardona, P
Molina, C
Rodriguez-Campello, A
Canovas, D
Krupinski, J
Ustrell, X
Torres, F
San Roman, L
Salvat-Plana, M
Jimenez-Fabrega, FX
Palomeras, E
Catena, E
Colom, C
Cocho, D
Baiges, J
Aragones, JM
Diaz, G
Costa, X
Almendros, MC
Rybyeba, M
Barcelo, M
Carrion, D
Lopez, MN
Sanjurjo, E
de la Ossa, NP
Urra, X
Chamorro, A
author_role author
author2 Rios, J
Rodriguez, A
Gomis, M
Vera, V
Gomez-Choco, M
Renu, A
Matos, N
Llull, L
Purroy, F
Amaro, S
Terceno, M
Obach, V
Serena, J
Marti-Fabregas, J
Cardona, P
Molina, C
Rodriguez-Campello, A
Canovas, D
Krupinski, J
Ustrell, X
Torres, F
San Roman, L
Salvat-Plana, M
Jimenez-Fabrega, FX
Palomeras, E
Catena, E
Colom, C
Cocho, D
Baiges, J
Aragones, JM
Diaz, G
Costa, X
Almendros, MC
Rybyeba, M
Barcelo, M
Carrion, D
Lopez, MN
Sanjurjo, E
de la Ossa, NP
Urra, X
Chamorro, A
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Thrombectomy
Stroke
Prognosis
Outcome
Registries
Propensity score
topic Thrombectomy
Stroke
Prognosis
Outcome
Registries
Propensity score
description 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.
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5224
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5224
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv KOREAN STROKE SOC
publisher.none.fl_str_mv KOREAN STROKE SOC
dc.source.none.fl_str_mv Journal of Stroke
ISSN: 22876391
ISSNe: 22876405
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869414427420262400
score 15,812455

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