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Severe ischemic stroke confers worse outcomes in Asian-Americans

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Asian-American patients with acute ischemic stroke had worse functional outcomes, had more severe ischemic strokes and received IV tissue plasminogen activator less often compared with white patients, according to a poster presented at the International Stroke Conference.

“These findings warrant additional research and more dedicated interventions toward improving clinical outcomes for Asian-American patients with acute ischemic stroke,” Sarah Y. Song, MD, MPH, assistant professor in the department of neurological sciences at Rush Medical College in Chicago and director of the Women’s Comprehensive Stroke Clinic at Rush University, and colleagues wrote.

Researchers analyzed data from 1,772,299 patients (mean age, 72 years; 51% women; 3.6% Asian-Americans) from the Get With the Guidelines-Stroke program who were admitted for acute ischemic stroke. Data included treatment patterns, clinical characteristics and outcomes.

According to the researchers, compared with white patients, Asian-American patients had:

• Higher in-hospital mortality (5.5% vs. 5.3%; adjusted OR = 1.14; 95% CI, 1.09-1.19)

• Greater prevalence of NIH Stroke Scale score 16 (16.1% vs. 14.7%; adjusted OR = 1.35; 95% CI, 1.3-1.4)

• Poorer functional recovery as defined by the modified Rankin Scale (score of 0 or 1 since 2012: 28.2% vs. 29.8%; adjusted OR = 0.8; 95% CI, 0.76-0.83)

• Less frequent use of IV tPA within 3 hours (adjusted OR = 0.8; 95% CI, 0.72-0.91); and

• More hemorrhagic and serious complications.

After adjusting for the NIH Stroke Scale, Asian-American patients were less likely to have in-hospital mortality compared with white patients (OR = 0.95; 95% CI, 0.91-0.99).

Both Asian-American and white patients had a statistically significant increasing trend for improved quality-of-life measures, decreased symptomatic intracerebral hemorrhage after tPA, IV tPA usage, and decreased in-hospital mortality after adjusting for time trends. Both groups also had an increased trend for receiving IV tissue plasminogen activator within 60 minutes, with Asian-American patients having a significantly larger increasing trend compared with white patients.

White patients also had an increasing trend for discharge to home and a decreasing trend for stroke severity.

"I’m glad this study is shining a light on the need for more research in Asian-American stroke,” Song told Cardiology Today. – by Darlene Dobkowski

Reference:

Song SY, et al. Abstract TMP75. Presented at: International Stroke Conference; Jan. 23-26, 2018; Los Angeles.

Disclosures: Song reports no relevant financial disclosures.