EVT for large vessel ischemic stroke less likely in patients with osteoarthritis
Click Here to Manage Email Alerts
Despite similar outcomes following endovascular thrombectomy anterior large vessel ischemic stroke, patients with osteoarthritis were 22.5% less likely to undergo EVT compared with those without it, researchers reported.
“Osteoarthritis and other musculoskeletal disorders are the leading causes of disability in the United States,” Huanwen Chen, MD, neurology resident at the National Institute of Neurological Disorders and Stroke of the NIH, and colleagues wrote. “While osteoarthritis is not a direct risk factor for stroke, osteoarthritis may impact patient selection for endovascular thrombectomy (EVT) due to prestroke disability. This study investigates associations of osteoarthritis with EVT utilization and outcomes.”
The study was published in Stroke.
Chen and colleagues utilized the 2016 to 2019 National Inpatient Sample database to identify 252,500 adult patients with anterior large vessel ischemic stroke, of which 8.5% also had osteoarthritis.
The primary outcome was rate of EVT treatment. Secondary outcomes included rate of discharge to home and in-hospital mortality.
Researchers observed that patients with osteoarthritis were older (77 vs. 71 years; P < .001); more likely to be women (66.3% vs. 50.4%; P < .001); and more likely to have had embolic strokes (74.5% vs. 72%; P < .001) than those without osteoarthritis.
Regarding stroke risk factors, patients with osteoarthritis had higher prevalence of hypertension, hyperlipidemia and atrial fibrillation/atrial flutter (P for all < .05).
After propensity score matching and multivariable logistic regression analysis, researchers reported that osteoarthritis was associated with 22.6% lower odds of receiving EVT in patients who experienced anterior large vessel ischemic stroke (OR = 0.77; 95% CI, 0.7-0.86; P < .001).
“There is currently little guidance on how to assess non-neurological disability during acute triage and using prestroke [modified Rankin Scale] to quantify disability from osteoarthritis and other musculoskeletal diseases has not been validated,” the researchers wrote. “Results from this study present the possibility that patients with pre-existing musculoskeletal diseases such as osteoarthritis may be excluded from EVT due to prestroke disability despite no strong evidence suggesting that their disease is associated with poor post-EVT outcomes.”
Among patients who underwent EVT, patients with osteoarthritis did not have any lower odds of being discharged home compared with patients without osteoarthritis (OR = 0.99; 95% CI, 0.81-1.21; P = .93); however, patients with osteoarthritis did have slightly lower odds of in-hospital mortality (OR = 0.74; 95% CI, 0.54-1.01; P = .054), according to the study.
“Patients with osteoarthritis had lower rates of in-hospital mortality. This association may indicate that patients with osteoarthritis selected for EVT may be in better health than patients without osteoarthritis, suggesting that clinicians nationwide may be more selective with osteoarthritis patients than with other patients when considering them for EVT therapy,” the researchers wrote. “Another possibility is that osteoarthritis patients may be on chronic non-steroidal anti-inflammatory drugs (NSAIDs), which have inherent antiplatelet activity and can improve stroke outcomes.”
Collapse
Read more about
Click Here to Manage Email Alerts