Mortality within three months after nonfatal ischemic stroke treated by mechanical thrombectomy in routine care—data from the German Stroke Registry

Abstract

Background: Mechanical thrombectomy (MT) is a highly effective treatment for large vessel occlusion (LVO) ischemic stroke. However, a substantial share of patients have lethal outcome within 3 months. Individualization of outcome prognostication is needed to support clinical decision-making throughout the care pathway after MT. We investigate predictors of lethal outcome in patients with nonfatal LVO, defined by discharge alive from primary treating hospital, in a large prospective registry study of MT under routine care conditions. Methods: 6,518 patients with nonfatal LVO treated by MT enrolled in the German Stroke Registry-Endovascular Treatment from May 2015-December 2021 were analysed with regard to lethal outcome by 3 month follow-up. Univariate group comparisons and multiple logistic regression analysis were performed to identify patients with high odds for survival or lethal outcome. Results: We report 11.6% (757/6,518) 3 month mortality following hospital discharge after LVO treated by MT. Besides better functional outcome at discharge (modified Rankin scale < 4, odds ratio, OR [95% confidence interval, CI]: 2.38 [1.71–3.32], p < 0.001; National Institute of Health Stroke scale < 8, OR [95%CI]: 3.45 [2.55–4.66], p < 0.001), intravenous thrombolysis (OR [95%CI]: 1.48 [1.17–1.88], p = 0.001), successful recanalization (OR [95%CI]: 1.43 [1.08–1.90], p = 0.014) and discharge to a neurorehabilitative facility (versus nursing home: OR [95%CI]: 0.39 [0.26–0.58], p < 0.001; versus home: OR [95%CI]: 0.69 [0.49–0.97], p = 0.032) were independent predictors of survival. Predictors of lethal outcome were older age (OR [95%CI]: 1.09 [1.07–1.10], p < 0.001), male sex (OR [95%CI]: 1.24 [1.00–1.55], p = 0.049), premorbid disability (OR [95%CI]: 1.47 [1.08–2.02], p = 0.016), active smoking (OR [95%CI]: 1.51 [1.06–2.14], p = 0.023), anticoagulation therapy prior to LVO (OR [95%CI]: 1.45 [1.09–1.92], p = 0.010), stroke etiology, general anaesthesia during MT (OR [95%CI]: 1.31 [1.02–1.69], p = 0.035) and intracerebral haemorrhage (OR [95%CI]: 1.50 [1.13–1.99], p = 0.005). Conclusions: Lethal outcome after hospital discharge within 3 months after MT is frequent, accounting for more than one quarter of overall 3-month mortality after MT of LVO. Predictors of survival enable individual outcome prognostication, which assists clinical decision-making with regard to surveillance concerning complications, rehabilitative resource allocation and counselling about goals of care. Trial registration: ClinicalTrials.gov (Identifier: NCT03356392, Date of registration: 2017/11/22).