Predictors of mortality in acute ischemic stroke treated with endovascular thrombectomy despite successful reperfusion: subgroup analysis of a multicentre randomised clinical trial

Hao Li, Jinbo Huang, Shisheng Ye, Hai Chen, Li Yuan, Geng Liao, Weijie Du, Chaomao Li, Ling Fang, Sheng Liu, Pengfei Yang, Yongwei Zhang, Pengfei Xing, Xiaoxi Zhang, Xiaofei Ye, Ya Peng, Jie Cao, Liyong Zhang, Zhi Yang, Jianmin Liu, DIRECT-MT investigators, Pengfei Yang, Yongwei Zhang, Lei Zhang, Yongxin Zhang, Kilian M Treurniet, Wenhuo Chen, Ya Peng, Hongxing Han, Jiyue Wang, Shouchun Wang, Congguo Yin, Sheng Liu, Peng Wang, Qi Fang, Hongchao Shi, Jianhong Yang, Changming Wen, Conghui Li, Changchun Jiang, Jun Sun, Xincan Yue, Min Lou, Meng Zhang, Hansheng Shu, Dianjing Sun, Hui Liang, Tong Li, Fuqiang Guo, Kaifu Ke, Haicheng Yuan, Guoping Wang, Weimin Yang, Huaizhang Shi, Tianxiao Li, Zifu Li, Pengfei Xing, Ping Zhang, Yu Zhou, Hao Wang, Yi Xu, Qinghai Huang, Tao Wu, Rui Zhao, Qiang Li, Yibin Fang, Laixing Wang, Jianping Lu, Yansheng Li, Jianhui Fu, Xihua Zhong, Yongjun Wang, Longde Wang, Mayank Goyal, Diederik W J Dippel, Bo Hong, Benqiang Deng, Yvo B W E M Roos, Charles B L M Majoie, Jianmin Liu, Hao Li, Jinbo Huang, Shisheng Ye, Hai Chen, Li Yuan, Geng Liao, Weijie Du, Chaomao Li, Ling Fang, Sheng Liu, Pengfei Yang, Yongwei Zhang, Pengfei Xing, Xiaoxi Zhang, Xiaofei Ye, Ya Peng, Jie Cao, Liyong Zhang, Zhi Yang, Jianmin Liu, DIRECT-MT investigators, Pengfei Yang, Yongwei Zhang, Lei Zhang, Yongxin Zhang, Kilian M Treurniet, Wenhuo Chen, Ya Peng, Hongxing Han, Jiyue Wang, Shouchun Wang, Congguo Yin, Sheng Liu, Peng Wang, Qi Fang, Hongchao Shi, Jianhong Yang, Changming Wen, Conghui Li, Changchun Jiang, Jun Sun, Xincan Yue, Min Lou, Meng Zhang, Hansheng Shu, Dianjing Sun, Hui Liang, Tong Li, Fuqiang Guo, Kaifu Ke, Haicheng Yuan, Guoping Wang, Weimin Yang, Huaizhang Shi, Tianxiao Li, Zifu Li, Pengfei Xing, Ping Zhang, Yu Zhou, Hao Wang, Yi Xu, Qinghai Huang, Tao Wu, Rui Zhao, Qiang Li, Yibin Fang, Laixing Wang, Jianping Lu, Yansheng Li, Jianhui Fu, Xihua Zhong, Yongjun Wang, Longde Wang, Mayank Goyal, Diederik W J Dippel, Bo Hong, Benqiang Deng, Yvo B W E M Roos, Charles B L M Majoie, Jianmin Liu

Abstract

Objectives: We sought to determine the predictors of 90-day mortality despite successful reperfusion.

Design: Subgroup analysis of a multicentre randomised clinical trial (ClinicalTrials.gov Identifier: NCT03469206).

Setting: This study used data from the Direct Intra-arterial thrombectomy in order to Revascularize AIS patients with large vessel occlusion Efficiently in Chinese Tertiary hospitals: a Multicenter randomized clinical Trial (DIRECT-MT).

Participants: 622 patients enrolled in DIRECT-MT.

Results: Overall successful reperfusion rate was 82.0% (510/622), and 18.5% (115/622) of patients died within 90 days. Univariate analysis identified increased risks of mortality for age ≥70 years, history of diabetes mellitus, National Institutes of Health Stroke Scale (NIHSS) score on admission ≥17, NIHSS score after thrombectomy (24±6 hours) ≥11, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) <9, glucose level at hospital arrival ≥130 mg/dL, location of internal carotid artery occlusion, embolisation into a new territory, symptomatic intracranial haemorrhage (ICH) and a decreased risk of mortality for smoking. In multivariable analysis, smoking (OR 0.38; 95% CI 0.17 to 0.83; p=0.015), NIHSS score on admission ≥17 (OR 3.14; 95% CI 1.77 to 5.55; p<0.001), glucose level at hospital arrival ≥130 mg/dL (OR 2.54; 95% CI 1.51 to 4.27; p<0.001), symptomatic ICH (OR 11.70; 95% CI 4.74 to 28.89; p<0.001) and NIHSS score after thrombectomy (24±6 hours) ≥11 (OR 12.04; 95% CI 5.09 to 28.46; p<0.001) were significant independent predictors of 90-day mortality.

Conclusions: Symptomatic ICH and high post-thrombectomy NIHSS score are strong predictor of 90-day mortality in acute ischaemic stroke treated with mechanical thrombectomy despite successful reperfusion, as well as high NIHSS score and high glucose level at hospital arrival. However, further studies need to be performed to confirm the association between smoking and mortality.

Keywords: neurology; neurosurgery; stroke.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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