Abstract W MP36: IV tPA Utilization and Outcomes in Asian Americans
Intro: Studies have shown race/ethnic differences in IV tPA utilization and outcomes after acute ischemic stroke (IS). Most studies in the US have examined differences in Black, White, and Hispanic populations. We aimed to examine tPA utilization and outcomes in Asian Americans.
Methods: We used administrative claims data on all discharges from nonfederal EDs and acute care hospitals in CA, FL, and NY from 2006 through 2011 (CA and NY) or 2012 (FL). We identified patients with a first-recorded hospitalization for IS using a validated algorithim and included discharge diagnosis of ICH or SAH if treated with tPA to capture cases of hemorrhagic transformation of an infarct. IV tPA was identified by ICD-9-CM procedure code 99.10. We used descriptive statistics to compare rates of IV tPA among different races. We used multiple logistic regression to assess the relationship between race and IV tPA use while adjusting for other demographic characteristics, vascular risk factors, and Elixhauser comorbid conditions. We assessed rates of ICH/SAH and inhospital mortality by race in patients treated with tPA.
Results: Among 587,560 IS patients, 63.9% were White, 14.1% Black, 12.5% Hispanic, 4.5% Asian, 0.2% American Indian, and 2.8% other; 2.0% had missing data on race. Mean age was 72 years and 52% were women. Overall 4.8% received IV tPA. tPA use was 5.1% in Whites, 3.9% in Blacks, 3.9% in Hispanics, and 4.7% in Asians. After adjusting for age, gender, insurance status, and comorbidities, tPA use was less likely in non-White patients: Black OR 0.78 (95% CI 0.75-0.81), Hispanic OR 0.78 (95% CI 0.75-0.81), and Asian OR 0.94 (95% CI 0.88-0.995). ICH/SAH after tPA occurred in 16.9% of Asians compared with 11.3% of Whites, 12.2% of Blacks, and 13.6% of Hispanics. In multivariable analysis, Asian race was independently associated with ICH/SAH (OR 1.51; 95% CI 1.29-1.77). In-hospital mortality was also significantly higher in Asians (14.7%) compared to whites (12.6%); OR 1.19 (1.00-1.4).
Conclusion: Asian patients less often receive tPA for IS. They also have higher rates of hemorrhage and in-hospital death after tPA. These findings are limited by lack of data on stroke severity, mechanisms, and treatment times. Further studies including these patient characteristics are warranted.
Author Disclosures: J.Y. Chong: None. B.B. Navi: None. H. Kamel: Speakers' Bureau; Significant; Genentech. Consultant/Advisory Board; Significant; Genentech.
- © 2015 by American Heart Association, Inc.