Abstract W P305: Processes Trends and Current Clinical Outcomes for IV TPA and Endovascular Stroke Therapies from the INterventional Stroke Therapy Outcomes Registry
Background: There is no national stroke registry that tracks emergency intra-hospital processes of care and 90-day clinical outcomes for both IV TPA and/or emergency endovascular stroke treatment (EVT). We created the INterventional Stroke Therapy Outcomes Registry (INSTOR®) to address this lack of data.
Methods: INSTOR is a sophisticated point-and-click analytical tool that tracks emergency processes and clinical outcomes (90-day modified Rankin Scale (mRS) in standard stacked bar chart) for both IV TPA and EVT for acute stroke. Complex analyses are performed in real-time and presented in multiple graphic formats. Single and multivariate risk adjustment for IV TPA and EVT therapies are performed based upon the presence or absence of diabetes, initial stroke severity, age, hypertension, atrial fibrillation, and, for EVT, original location of clot.
Results: Since start of use of INSTOR over 30 months ago (data from 10 sites, over 2368 patients, 542 treated ischemic strokes), median times for arrival to CT have declined from 31 to 17 minutes and scan interpretation from 47 to 40 minutes. Arrival to IV TPA has declined from 81 to 70 minutes, and “decision” (TPA-order) to TPA-started from 20 to 13 minutes. Current 90-day mRS 0-1 for IV TPA (minimum NIHSS null, median 11, maximum 36) is 16% for diabetic patients versus 26% for non-diabetic patients. For IV TPA patients, the overall percentage of mRS 0-1 is 22.6 while mRS 0-2 is 44%. However, for those presenting with NIHSS 6-9, mRS 0-2 at 90-days is 76% while those presenting with NIHSS 10-14, it is 43%. For EVT (minimum NIHSS null, median 17, maximum 38), 90-day mRS 0-2 for IV+EVT is 56% at 90-days vs. 32% for EVT alone and variation is shown based upon original clot location. The rate of symptomatic intracranial hemorrhage is 3.8% for IV TPA alone, 6.6% for IV+EVT, and 8.7% for EVT alone.
Conclusions: INSTOR is a unique quality improvement tool that presents instant online graphical and numerical analyses of numerous processes of care and clinical outcomes that can be used to improve care.
Author Disclosures: J.J. Connors: Other; Modest; Board of Directors: NVRF. M.J. Alberts: Speakers' Bureau; Modest; Genentech. R. Novakovic: None.
- © 2014 by American Heart Association, Inc.