BMJ Open (Mar 2022)
Predictors of mortality in acute ischemic stroke treated with endovascular thrombectomy despite successful reperfusion: subgroup analysis of a multicentre randomised clinical trial
- Rui Zhao,
- Lei Zhang,
- Yongjun Wang,
- Changchun Jiang,
- Yi Xu,
- Mayank Goyal,
- Hao Wang,
- Meng Zhang,
- Fuqiang Guo,
- Tong Li,
- Shisheng Ye,
- Hao Li,
- Qiang Li,
- Xiaoxi Zhang,
- Pengfei Yang,
- Yibin Fang,
- Bo Hong,
- Qinghai Huang,
- Jianmin Liu,
- Ya Peng,
- Wenhuo Chen,
- Shouchun Wang,
- Hongchao Shi,
- Zifu Li,
- Longde Wang,
- Min Lou,
- Tao Wu,
- Peng Wang,
- Changming Wen,
- Xiaofei Ye,
- Hui Liang,
- Jie Cao,
- Sheng Liu,
- Li Yuan,
- Tianxiao Li,
- Huaizhang Shi,
- Zhi Yang,
- Hai Chen,
- Yu Zhou,
- Jianhui Fu,
- Qi Fang,
- Jun Sun,
- Geng Liao,
- Liyong Zhang,
- Yongwei Zhang,
- Yongxin Zhang,
- Pengfei Xing,
- Hongxing Han,
- Haicheng Yuan,
- Kaifu Ke,
- Guoping Wang,
- Diederik W.J. Dippel,
- Charles B.L.M. Majoie,
- Yvo B.W.E.M. Roos,
- Kilian M. Treurniet,
- Jiyue Wang,
- Benqiang Deng,
- Congguo Yin,
- Conghui Li,
- Dianjing Sun,
- Xincan Yue,
- Jianhong Yang,
- Weimin Yang,
- Hansheng Shu,
- Jianping Lu,
- Ling Fang,
- Jinbo Huang,
- Weijie Du,
- Chaomao Li,
- Laixing Wang,
- Yansheng Li,
- Xihua Zhong
Affiliations
- Rui Zhao
- 2Genentech, Inc., South San Francisco, United States of America
- Lei Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
- Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Changchun Jiang
- Yi Xu
- Department of Thoracic Surgery, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Mayank Goyal
- 1 Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hao Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Meng Zhang
- Department of General Practice, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- Fuqiang Guo
- 9 Department of Neurology, Sichuan Provincial People’s Hospital, Chengdu, China
- Tong Li
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Shisheng Ye
- 1 Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People’s Hospital, Shenzhen, China
- Hao Li
- 1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Qiang Li
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
- Xiaoxi Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
- Pengfei Yang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Yibin Fang
- Department of Neurosurgery, Changhai Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China
- Bo Hong
- Neurovascular Center, Changhai Hospital，Naval Medical University, Shanghai, China
- Qinghai Huang
- Neurovascular Center, Changhai Hospital, Second Military Medical University, Shanghai, China
- Jianmin Liu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Ya Peng
- 12 Department of Neurosurgery, Changzhou No. 1 People`s Hospital, Changzhou, China
- Wenhuo Chen
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Shouchun Wang
- Hongchao Shi
- Zifu Li
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
- Longde Wang
- 3 Stroke Prevention and Control Steering Committee, National Health Commission of the People’s Republic of China, Beijing, China
- Min Lou
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital Department of Neurology, Hangzhou, Zhejiang, China
- Tao Wu
- Fudan University School of Pharmacy, Shanghai, China
- Peng Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
- Changming Wen
- Xiaofei Ye
- Department of Statistics, Naval Medical University, Shanghai, China
- Hui Liang
- Jie Cao
- 1 Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Sheng Liu
- Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Li Yuan
- 2 Guangdong Women and Children Hospital, Guangzhou, China
- Tianxiao Li
- Huaizhang Shi
- 1 Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Zhi Yang
- 1 Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Hai Chen
- 1 Department of Neurology, Maoming People’s Hospital, Maoming, China
- Yu Zhou
- Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, Chongqing, China
- Jianhui Fu
- 5 Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- Qi Fang
- 1 Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Jun Sun
- 1 University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
- Geng Liao
- Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
- Liyong Zhang
- Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng City, Shandong, China
- Yongwei Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
- Yongxin Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
- Pengfei Xing
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
- Hongxing Han
- Haicheng Yuan
- 16 Neurology, Qingdao Central Medical Group, Qingdao, China
- Kaifu Ke
- Guoping Wang
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
- Diederik W.J. Dippel
- Charles B.L.M. Majoie
- Yvo B.W.E.M. Roos
- Kilian M. Treurniet
- Jiyue Wang
- Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng City, Shandong Province, China
- Benqiang Deng
- Congguo Yin
- Department of Neurology, Hangzhou First People`s Hospital, Hangzhou, Zhejiang, China
- Conghui Li
- Department of Neurosurgery, Hebei Medical University First Affiliated Hospital, Shijiazhuang, Hebei, China
- Dianjing Sun
- Xincan Yue
- Jianhong Yang
- Department of Neurology, Ningbo First Hospital, Ningbo, China
- Weimin Yang
- Hansheng Shu
- Jianping Lu
- 1 Radiology, Changhai Hospital, Shanghai, China
- Ling Fang
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Jinbo Huang
- Clinical Research Center, Center of Scientific Research, Maoming People`s Hospital, Maoming, Guangdong, China
- Weijie Du
- Department of Neurology, Maoming People’s Hospital, Maoming, China
- Chaomao Li
- Department of Neurology, Maoming People’s Hospital, Maoming, China
- Laixing Wang
- Yansheng Li
- Xihua Zhong
- DOI
- https://doi.org/10.1136/bmjopen-2021-053765
- Journal volume & issue
-
Vol. 12,
no. 3
Abstract
Objectives We sought to determine the predictors of 90-day mortality despite successful reperfusion.Design Subgroup analysis of a multicentre randomised clinical trial (ClinicalTrials.gov Identifier: NCT03469206).Setting This study used data from the Direct Intra-arterial thrombectomy in order to Revascularize AIS patients with large vessel occlusion Efficiently in Chinese Tertiary hospitals: a Multicenter randomized clinical Trial (DIRECT-MT).Participants 622 patients enrolled in DIRECT-MT.Results Overall successful reperfusion rate was 82.0% (510/622), and 18.5% (115/622) of patients died within 90 days. Univariate analysis identified increased risks of mortality for age ≥70 years, history of diabetes mellitus, National Institutes of Health Stroke Scale (NIHSS) score on admission ≥17, NIHSS score after thrombectomy (24±6 hours) ≥11, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) <9, glucose level at hospital arrival ≥130 mg/dL, location of internal carotid artery occlusion, embolisation into a new territory, symptomatic intracranial haemorrhage (ICH) and a decreased risk of mortality for smoking. In multivariable analysis, smoking (OR 0.38; 95% CI 0.17 to 0.83; p=0.015), NIHSS score on admission ≥17 (OR 3.14; 95% CI 1.77 to 5.55; p<0.001), glucose level at hospital arrival ≥130 mg/dL (OR 2.54; 95% CI 1.51 to 4.27; p<0.001), symptomatic ICH (OR 11.70; 95% CI 4.74 to 28.89; p<0.001) and NIHSS score after thrombectomy (24±6 hours) ≥11 (OR 12.04; 95% CI 5.09 to 28.46; p<0.001) were significant independent predictors of 90-day mortality.Conclusions Symptomatic ICH and high post-thrombectomy NIHSS score are strong predictor of 90-day mortality in acute ischaemic stroke treated with mechanical thrombectomy despite successful reperfusion, as well as high NIHSS score and high glucose level at hospital arrival. However, further studies need to be performed to confirm the association between smoking and mortality.
