Futility in Survival: Predictors of 90-Day Poor Outcomes (mRS 4-5) After Endovascular Thrombectomy for Ischemic Stroke
Mohamed Fahmy Doheim1, Abdullah Al-Qudah1, Lucas Rios Rocha1, Anmol almast2, Nirav Bhatt1, Marcelo Rocha1, Matthew Starr1, Jussie Correia Lima1, Michael Lang3, Bradley Gross3, Raul Nogueira1, Alhamza Al-Bayati1
1Department of Neurology, University of Pittsburgh School of Medicine, UPMC Stroke Institute, 2University of Pittsburgh School of Medicine, 3University of Pittsburgh Medical Center, Department of Neurological Surgery
Objective:
To determine whether baseline and procedure characteristics can predict major disability in stroke survivors following endovascular thrombectomy (EVT).
Background:
Stroke survivors face substantial hurdles in achieving favorable outcome (Modified Rankin Scale [mRS] 0-3) within 90 days. While the mortality rate for stroke is around 25%, non-mortal futility (mRS 4-5) remains a particularly severe outcome. This condition imposes a significant burden on both the patients and the healthcare system.
Design/Methods:
We retrospectively analyzed patients who survive stroke following EVT. Functional outcomes were assessed using the mRS at 90 days; dichotomized into favorable (mRS 0-3) and unfavorable (mRS 4-5) outcomes. Baseline and procedure variables were compared between the groups using pairwise comparisons and multivariable logistic regression models to identify independent predictors.
Results:
Of the 643 patients analyzed, 506(78.7%) had favorable outcomes, and 137(21.3%) had unfavorable outcomes. Age (median[IQR] 68[57-77]years vs. 74[65 -81]years ,p<0.001), baseline NIHSS score (median [IQR] 15[10 – 19] vs. 17[14-21],p<0.001), baseline ASPECTS median [IQR] (9[8-10] vs 9[8-9],p<0.01), and last known well to arrival (LKWA) (median [IQR] 4.8h [2.8–11.03] vs 7.5h [3.4–13.7],p<0.01) were significantly higher in patients with unfavorable outcomes. In addition, prior histories of stroke and atrial fibrillation (14.0%vs.26.3%, p<0.01, 24.1%vs38.0%, p=0.002; respectively) were more prevalent in the group with unfavorable outcomes. Multivariable analysis confirmed that older age (aOR 1.04, 95% CI:1.02-1.06,p<0.001), prior history of stroke (aOR 2.18,95% CI:1.28-3.67,p=0.004), baseline NIHSS (aOR 1.07, 95% CI: 1.03-1.10,p=0.003), LKWA (aOR 1.01,95% CI:1.001-1.02, p=0.0003), higher number of passes (NP) (aOR 1.2, 95% CI:1.03–1.43,p=0.02), and lack of successful recanalization (TICI 2b-3, aOR 0.24, 95% CI:0.1–0.6,p=0.003) were independent predictors of non-mortal futility.
Conclusions:
Non-mortal futility in EVT for was linked to older age, prior history of stroke or atrial fibrillation, higher baseline NIHSS score, prolonged LKWA time, failure to achieving successful recanalization, and higher NP.
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