Abstract 134: Population-level Trends In Clinal Outcomes And Endovascular Stroke Therapy In Acute Ischemic Stroke

Abstract

Intro & Background: Following the publication of the randomized clinical trials in 2015 and 2018 on endovascular stroke therapy (EVT), procedural utilization has increased. The effect of EVT utilization on clinical outcomes in acute ischemic stroke (AIS) at the population-level, however, remains incompletely characterized. Methods & Materials: We performed a retrospective cross-sectional analysis using the Texas Public Use Data File with records from January 2016 through the first quarter of 2020. This dataset includes full sample data on all patients hospital discharged from all state-licensed hospitals. AIS hospitalizations were identified as those with a primary diagnosis of AIS by ICD-10 diagnostic codes. Patients <18 were excluded, as well as patients missing age data. EVT was defined using ICD-10 procedure codes. Excellent clinical outcome was defined as discharge to home. Trends for EVT and percentage of home discharge were assessed by quarter and the correlation between two trends were examined by cross-correlation. Results: Among 165,738 AIS cases, 61% were over 65 years old, 51% were female, 51% were White and 25% were Hispanic. Over the course of the study period, EVT utilization increased 0.25% per quarter [95% CI 0.23-0.27, P<0.001]. Excellent clinical outcomes also increased over this time period, with a 0.21% quarterly increase in patients being discharged home [95% CI 0.16-0.25, p<0.001] (Figure). At the population-level, we observed a positive correlation between increasing EVT utilization and excellent clinical outcomes (R=0.64, p< 0.003). Conclusion: In this state-wide cohort, increasing usage of EVT was positively correlated with excellent clinical outcomes. These data provide evidence for population-level improvements in AIS care with improving EVT access and utilization.