Faculty Collaboration Database

Predictors of Mortality in Acute Ischemic Stroke Intervention: Analysis of the North American Solitaire Acute Stroke Registry. Stroke 2015 Aug;46(8):2305-8

Date

07/15/2015

Pubmed ID

26159790

DOI

10.1161/STROKEAHA.115.009530

Scopus ID

2-s2.0-84944672621 (requires institutional sign-in at Scopus site)   48 Citations

Abstract

BACKGROUND AND PURPOSE: Failure to recanalize predicts mortality in acute ischemic stroke. In the North American Solitaire Acute Stroke registry, we investigated parameters associated with mortality in successfully recanalized patients.

METHODS: Logistic regression was used to evaluate baseline characteristics and recanalization parameters for association with 90-day mortality. A multivariable model was developed based on backward selection with retention criteria of P<0.05 from factors with at least marginal significance (P≤0.10), then refit to minimize the number of excluded cases (missing data).

RESULTS: Successfully recanalized patients had lower mortality (25.2% [59/234] versus 46.9% [38/81] P<0.001). There was no difference in symptomatic intracranial hemorrhage between patients with successful versus failed recanalization (9% [21/234] versus 14% [11/79]; P=0.205). However, mortality was significantly higher in patients with symptomatic intracranial hemorrhage (72% [23/32] versus 26% [73/281]; P<0.001). Proximal occlusion (internal carotid artery or vertebrobasilar), initial National Institutes of Health Stroke Scale≥18, use of rescue therapy (P<0.05), and 3+ passes (P<0.10) were associated with mortality in recanalized patients. In the multivariate model with good predictive power (c index=0.72), proximal occlusion, initial National Institutes of Health Stroke Scale≥18, and use of rescue therapy remained significant independent predictors of 90-day mortality.

CONCLUSIONS: Failure to recanalize and presence of symptomatic intracranial hemorrhage resulted in increased mortality. Despite successful recanalization, proximal occlusion, high National Institutes of Health Stroke Scale, and need for rescue therapy were predictors of mortality.

Author List

Linfante I, Walker GR, Castonguay AC, Dabus G, Starosciak AK, Yoo AJ, Abou-Chebl A, Britz GW, Marden FA, Alvarez A, Gupta R, Sun CH, Martin C, Holloway WE, Mueller-Kronast N, English JD, Malisch TW, Bozorgchami H, Xavier A, Rai AT, Froehler MT, Badruddin A, Nguyen TN, Taqi MA, Abraham MG, Janardhan V, Shaltoni H, Novakovic R, Chen PR, Kaushal R, Nanda A, Issa MA, Nogueira RG, Zaidat OO

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Cerebral Revascularization
Female
Humans
Male
Mortality
North America
Predictive Value of Tests
Registries
Retrospective Studies
Risk Factors
Stroke
Treatment Outcome