Long-term outcomes and quality of life in stroke patients with extensive early infarction

*Clinical information for medical professionals only, 1s reach ▎Clinical question: In stroke patients with extensive early infarction, what is the correlation between reperfusion grade and long-term functional outcomes and long-term health-related quality of life? The benefit of mechanical thrombectomy on short-term outcomes in patients with low Alberta Stroke Program Early CT Scores (ASPECTS) is controversial, while long-term outcomes remain unclear
.

A retrospective single-center cohort study published in Stroke: Vascular and Interventional Neurology aimed to assess reperfusion grade and long-term functional outcomes as measured by the modified Rankin scale, based on baseline ASPECTS (0-5 vs.
6-10), and final Correlations between patients' long-term health-related quality of life recorded at one follow-up visit
.

Document screenshot▎Study protocol: The study identified deceased patients from the Swiss population registry and conducted telephone follow-up of all surviving stroke patients treated with mechanical thrombectomy between January 1, 2010, and December 31, 2018
.

Of the 1114 patients with long-term follow-up (median 3.
67 years), 997 were included in the final analysis
.

A modified Rankin score of 0-3 was classified as a good outcome; health-related quality of life was assessed using a 3-level version of the EuroQol 5-dimensional questionnaire
.

The EuroQol 5-dimensional utility index was calculated for statistical analysis
.

The reperfusion grade was determined by the core laboratory using the Extended Treatment Cerebral Ischemia Score
.

Adjusted odds ratios between grades of cerebral ischemia-reperfusion assessed by extended treatment and outcomes were calculated by multivariate logistic regression
.

 ▎Main findings: Patients with low ASPECTS were more often than those with high ASPECTS about activities of activity (67.
1% vs 42.
1%, P<0.
001), self-care (53.
4% ​​vs 31.
2%, P<0.
001) and activities of daily living (65.
8%) vs 41.
4%, P<0.
001), while there was no difference between pain/discomfort (65.
7% vs 69.
9%, P=0.
49) and anxiety/depression (71.
2% vs 78.
9%, P=0.
17)
.

In patients with low ASPECTS, despite early extensive infarction, increased reperfusion grade was associated with better long-term functional outcomes (adjusted odds ratio, 1.
43; 95% CI, 1.
09-1.
88, P=0.
01) and higher health-related life quality (adjusted linear correlation coefficient, 0.
05; 95% CI, 0.
02-0.
08)
.

▎Conclusions: Despite lower baseline ASPECTS, higher reperfusion grades lead to better functional outcomes and may improve long-term health-related quality of life
.

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