Research & Innovation
Publications
Early mortality in patients with acute ischemic stroke after endovascular stroke therapy
PMU Authors
Sebastian Mutzenbach, Monika Killer-Oberpfalzer, Johannes Alex Rolf Pfaff
All Authors
Alexander Pichler, Alexandra Posekany, Dominika Miksova, Simon Fandler-Hoefler, Hannes Deutschmann, Markus Kneihsl, Stephan Seiler, Sebastian Mutzenbach, Monika Killer-Oberpfalzer, Elke R. Gizewski, Michael Knoflach, Stefan Kiechl, Michael Sonnberger, Joachim Gruber, Joerg Weber, Luca De Paoli, Stefan Greisenegger, Florian Wolf, Philipp Werner, Dimitre Staykov, Peter Sommer, Marek Sykora, Julia Ferrari, Christian Nasel, Johannes Alex Rolf Pfaff, Christian Enzinger, Thomas Gattringer,
Journal association
JOURNAL OF NEUROINTERVENTIONAL SURGERY
Abstract
Background/Aim Endovascular stroke therapy (EVT) improves functional outcome and reduces mortality in patients with large vessel occlusion. However, data on risk factors for early mortality after EVT are scarce. We investigated the predictive value of clinical information already available on the day of hospital admission on early mortality following EVT. Methods We analyzed data from the nationwide Austrian Stroke Unit Registry (ASUR) covering consecutive stroke patients that had received EVT between 2013 and 2023. We used multivariable regularized regression analysis to identify factors associated with early mortality (defined as deceased within 7 days post-stroke). We further tested the accuracy of a modified version of the 'Predicting Early Mortality of Ischemic Stroke' (mPREMISE) score extending the original model by post-EVT recanalization status. Results The data showed that 5900 patients (median age: 75 years, 52.4% female) had received EVT, of whom 340 (5.7%) died within 7 days after admission. Stroke severity at admission, followed by higher age, incomplete recanalization (Thrombolysis in Cerebral Infarction scores (TICI) <= 2 a), vertebrobasilar occlusion site, diabetes, chronic heart disease, and pre-stroke disability (modified Rankin Scale >1) were independently associated with early mortality. The area under the receiver operating curve (AUC-ROC) for the mPREMISE score was 0.74 (95% confidence interval (CI), 0.71 to 0.77). Patients with a score >= 9 had a 25.8% (95% CI, 25.4 to 26.2%) risk of early mortality. Conclusion In this nationwide analysis, we identified risk factors for early mortality after EVT that can be assessed on the admission day. The mPREMISE score seems to be a reasonable tool for estimating early mortality in stroke patients undergoing EVT.
Keywords
THROMBECTOMY, STROKE