Black Patients Present Greater Association With Comorbidities Prior to Ischemic Stroke

There was no significant association between Black race and clinical outcome following mechanical thrombectomy.

Data from a recent study suggest that Black patients were more likely to have comorbidities ahead of ischemic stroke. Comparably, investigators found no significant association between Black race and clinical outcome following mechanical thrombectomy.1

Findings from the cohort study were presented at the 2022 International Stroke Conference (ISC), February 9-11, in New Orleans, Louisiana. Demographic data, clinical information, and outcomes measures for 3597 patients with ischemic stroke who were treated with mechanical thrombectomy were collected from the NeuroVascular Quality Initiatives Quality Outcomes Database, with Black patients comprising 15.8% of the cohort.

Investigators, including Dilip Pandey, MD, PhD, FAHA, associate professor, Department of Neurology and Rehabilitation, University of Illinois at Chicago, conducted a univariate analysis and found that Black race was significantly associated with younger age at time of treatment, chronic heart failure, hypertension, diabetes, prior stroke, being a current smoke, and higher baseline National Institutes of Health Stroke Scale (NIHSS) scores, averaging 16.4 for Black participants, compared to 15.8 for those who were non-Black (P = .044).

Atrial fibrillation and hyperlipidemia at baseline were both significantly associated with non-Black race. Comparably, Black race was not significantly associated with discharge Modified Rankin Scale (mRS) score at discharge, discharge to home, or mRS score at 90days (all P >.3) on both univariate and multivariate analyses.

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“Prior evidence suggests that treatment outcomes after ischemic stroke differ based on racial background. For example, two studies that queried the National Inpatient Sample (NIS) found that White patients were more likely to be discharged home compared to non-White patients after treatment with mechanical thrombectomy or IV tPA [tissue-type plasminogen activator],” Pandey et al wrote. “Although these database studies provide the advantage of substantial patient numbers, the NIS is an inpatient administrative dataset lacking stroke-specific outcomes such as mRSand follow-up data. Nevertheless, a relationship between race and clinical outcome after thrombectomy is suggested.”

Pandey et al conducted univariate and multivariate analysis in order to evaluate the relationship between race and outcomes, namely mRS score at discharge, discharge disposition, and mRS score at 90 days. Investigators used race as a predictor of variable of interest and was included in multivariate modeling.

Additional findings presented at ISC 2022 found that implementing telestroke, in addition to standardized workflows, in facilities contributed to the provision of equitable care regarding raceand gender on endovascular odds. Of the 1519 patients with large vessel occlusion included in the study, 918 underwent endovascular treatment.2

Increased age (odds ratio [OR], 0.98; 95% CI, 0.98-0.99; P = .000), an initial NIHSS score greater than 6 (OR, 7.89; 95% CI, 5.85-10.64; P <.0001), arrival to the ED by emergency medical service, and shorter time to ED arrival (OR, 0.92; 95% CI, 0.90-0.94; P <.0001) were all associated with increased treatment rates, as anticipated by investigators.

In multivariate models, investigators did not observe differences in sex (OR, 1.03; 95% CI, 0.79-1.36; P = .808), healthcare membership (OR, 0.91; 95% CI, 0.64-1.31; P = .623), or race (multi-race vs white: OR, 0.74; 95% CI 0.49-1.13; P = .167) in those who received endovascular stroke treatment when compared with those that did not. When considering 90-day mortality rates by race (P = .085), there were no differences, and nontreatment was found to be primarily associated with the patient or family refusal or poor baseline functioning.

For more coverage of ISC 2022, click here.

REFERENCE
1. Fuentes AM, Du X, Pandey DK, Ansari SA, Amin-hanjani S. Mechanical thrombectomy for ischemic stroke: Evaluating outcome associations with race. Presented at ISC 2022; February 9-11; New Orleans, LA and Virtual. Abstract WP149.
2. Zrelak PA, Alexander J, Klingman J, Nguyen-huynh MN. Use of tele-stroke in a large integrated healthcare system demonstrate no disparities in endovascular treatment for stroke. Presented at ISC 2022; February 9-11; New Orleans, LA and Virtual. Abstract TP160.