Osteoarthritis is associated with lower likelihood of receiving stroke thrombectomy despite similar post-thrombectomy outcomes: a national study
Huanwen Chen1, Mihir Khunte2, Marco Colasurdo3, Gaurav Jindal3, Ajay Malhotra5, Dheeraj Gandhi3, Seemant Chaturvedi4
1National Institute of Neurological Disorders and Stroke, National Institutes of Health, 2Warren Alpert Medical School, Brown University, 3Interventional Neuroradiology, 4Neurology, University of Maryland Medical Center, 5Radiology and Biomedical Imaging, Yale University
Objective:
To investigate whether osteoarthritis (OA) impacts stroke thrombectomy treatment rates or post-thrombectomy outcomes.
Background:
Osteoarthritis (OA) is a common condition affecting as many as 30 million Americans. While OA is not a direct risk factor for acute ischemic stroke, it can be associated with pre-stroke disability and influence patient selection for endovascular thrombectomy (EVT). Whether OA impacts post-EVT outcomes is currently unknown.
Design/Methods:
This was a retrospective study of the 2016-2019 National Inpatient Sample database. Adult patients with large vessel acute ischemic stroke were included. Patients with osteoarthritis were identified. Primary outcome was rate of EVT treatment in OA patients versus non-OA patients. Secondary outcomes include rates of discharge to home and in-hospital mortality after EVT treatment. Propensity score-matching (PSM) and multivariable logistic regression models were used to account for possible confounders.
Results:
252,505 large vessel ischemic stroke patients were identified, of whom 21,500 patients (8.5% of study population) were diagnosed with OA. After PSM for 27 clinical variables, OA patients were 21.3% less likely to receive EVT than non-OA patients (14.4% vs. 18.3%, respectively; p<0.001). In multivariable logistic regression analysis, OA was associated with 31% lower odds of receiving EVT (OR 0.69 [95%CI 0.63 to 0.76], p<0.001), an effect size second only to dementia and larger than that of any other comorbidity captured in this study. Among patients who received EVT, multivariable logistic regression models showed that OA was not associated with different odds of being discharged home (OR 1.01 [95%CI 0.83 to 1.23], p=0.92); however, OA was associated with lower odds of in-hospital mortality compared to non-OA patients (OR 0.74 [95%CI 0.55 to 0.99], p=0.044).
Conclusions:
Large vessel ischemic stroke patients with OA were significantly less likely to receive EVT therapy despite similar post-EVT outcomes. These results warrant further investigation and prompt a critical review of current patient selection practices for EVT.