Acute ischemic stroke patients admitted to hospitals that perform percutaneous coronary interventions in the United
Adnan I Qureshi1, M Fareed K Suri2, Qaisar A Shah2
1Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA.
Insights
Mechanical thrombectomy (MT) for acute ischemic stroke is often available at hospitals performing percutaneous coronary intervention (PCI). Increasing MT at PCI-capable hospitals could improve access to this critical treatment in the US.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Health Services Research
Background:
- Mechanical thrombectomy (MT) is a crucial treatment for acute ischemic stroke.
- Hospitals performing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) may also be suitable for MT.
- The availability and utilization of MT in these PCI-capable hospitals in the US remain under-explored.
Purpose of the Study:
- To investigate the landscape of mechanical thrombectomy (MT) for acute ischemic stroke patients in US hospitals.
- To compare patient characteristics and outcomes across hospitals with varying capabilities in primary PCI and MT.
- To identify opportunities for expanding MT access by leveraging existing PCI infrastructure.
Main Methods:
- Analysis of nationally representative data from 2017-2020.
- Categorization of hospitals into three groups: performing both PCI and MT, performing PCI only, and performing neither.
- Logistic regression models to assess the impact of hospital type on in-hospital mortality and discharge home.
Main Results:
- Over 1.2 million acute ischemic stroke patients were admitted to hospitals performing both PCI and MT.
- Hospitals performing PCI only or neither PCI nor MT had lower in-hospital mortality compared to those performing both.
- No significant differences in discharge home rates were observed across the hospital types.
Conclusions:
- A significant proportion of acute ischemic stroke patients (nearly 37%) are treated at hospitals with PCI capabilities but without MT services.
- Strategies to implement MT in PCI-capable hospitals are recommended to enhance rapid availability of this treatment.
- Expanding MT services at PCI-performing hospitals could improve stroke care accessibility nationwide.
Background:
We explored the potential of mechanical thrombectomy (MT) for acute ischemic stroke patients at hospitals that perform percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in the United States.
Methods:
We analyzed nationally representative data between 2017 and 2020 to determine the numbers, characteristics, and outcomes of acute ischemic stroke patients admitted to hospitals that perform both primary PCI and MT, hospitals that perform primary PCI but not MT and hospitals that perform neither PCI or MT. Multiple logistic regressions were performed to evaluate the effect of hospital type on in-hospital mortality and discharge home (without palliative care).
Results:
A total of 1,210,415, 1,002,950, and 488,845 acute ischemic stroke patients were admitted to hospitals that performed both primary PCI and MT, performed primary PCI but not MT, or performed neither PCI nor MT, respectively. Compared with hospitals that performed both PCI and MT, the odds of in-hospital mortality were lower in hospitals that performed PCI only (odds ratio (OR) 0.88 95 % confidence interval (CI) 0.86-0.91, p<0.001) and hospitals that performed neither PCI or MT (OR 0.85 95 %CI 0.82-0.89, p<0.0010). There was no significant difference in the odds of discharge home between the three types of hospitals.
Conclusions:
Almost 37 % the patients with acute ischemic stroke are admitted to hospitals that perform primary PCI (but not MT) supporting strategies to increase the performance of MT in such hospitals as an option to increase rapid availability of MT in the United States.
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