5 research outputs found
Ensuring Emergency Medicine Performance Standards for Stroke and Transient Ischemic Attack Care
Racial Disparity in Mechanical Thrombectomy Utilization: Multicenter Registry Results From 2016 to 2020
Background Previous studies on racial disparity in mechanical thrombectomy (MT) treatment of acute large vessel occlusion stroke lack individual patient data that influence treatment decisionâmaking. We assessed patientâlevel data in a large US health care system from 2016 to 2020 for racial disparities in MT utilization and eligibility. Methods and Results A retrospective study was performed of 34Â 596 patients admitted to 43 hospitals from January 2016 to September 2020. Data included patient age, sex, race, residential zip code median income and population density, presenting hospital stroke certification, baseline ambulation, and National Institutes of Health stroke scale. The cohort included 26Â 640 White, nonâHispanic (77.0%), and 7956 African American/Black (23.0%) patients. In multivariable logistic regression, Black patients were less likely to undergo MT (adjusted odds ratio [OR], 0.65; 95% CI, 0.54â0.76), arrive within 5Â hours of âlast known wellâ (adjusted OR, 0.73; 95% CI, 0.69â0.78), and have documented anterior circulation large vessel occlusion (adjusted OR, 0.78; 95% CI, 0.64â0.96). Race was not associated with MT rate among patients arriving within 5Â hours of last known well with documented acute large vessel occlusion. Conclusions Black patients with stroke underwent MT less frequently than White patients, likely in part because of longer times from last known well to hospital arrival and a lower rate of documented acute large vessel occlusion. Further studies are needed to assess whether extending the MT time window and more aggressive large vessel occlusion screening protocols mitigate this disparity
Anticoagulation Strategies for Treatment of Ischemic Stroke and Antiphospholipid Syndrome: Case Report and Review of the Literature
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Coronary Artery Calcification (CAC) and PostâTrial Cardiovascular Events and Mortality Within the Women's Health Initiative (WHI) EstrogenâAlone Trial
Background: Among women aged 50 to 59 years at baseline in the Women's Health Initiative (WHI) EstrogenâAlone (EâAlone) trial, randomization to conjugated equine estrogenâalone versus placebo was associated with lower risk of myocardial infarction and mortality, and, in an ancillary study, the WHIâCACS (WHI Coronary Artery Calcification Study) with lower CAC, measured by cardiac computed tomography â8.7 years after baseline randomization. We hypothesized that higher CAC would be related to postâtrial coronary heart disease (CHD), cardiovascular disease (CVD), and total mortality, independent of baseline randomization or risk factors. Methods and Results: WHIâCACS participants (n=1020) were followed â8 years from computed tomography scan in 2005 (mean age=64.4) through 2013 for incident CHD (myocardial infarction and fatal CHD, n=17), CVD (n=69), and total mortality (n=55). Incident CHD and CVD analyses excluded women with CVD before scan (n=89). Women with CAC=0 (n=54%) had very low ageâadjusted rates/1000 personâyears of CHD (0.91), CVD (5.56), and mortality (3.45). In comparison, rates were â2âfold higher for women with any CAC (>0). Associations were not modified by baseline randomization to conjugated equine estrogenâalone versus placebo. Adjusted for baseline randomization and risk factors, the hazard ratio (95% confidence interval) for CAC >100 (19%) was 4.06 (2.11, 7.80) for CVD and 2.70 (1.26, 5.79) for mortality. Conclusions: Among a subset of postmenopausal women aged 50 to 59 years at baseline in the WHI EâAlone Trial, CAC at mean age of 64 years was strongly related to incident CHD, CVD, and to total mortality over â8 years, independent of baseline randomization to conjugated equine estrogenâalone versus placebo or CVD risk factors. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00000611