Trends of Acute Ischemic Stroke Reperfusion Therapies from 2012 to 2016 in the United States

Background: American Heart Association/American Stroke Association guidelines recommend endovascular stroke therapy (EST) with recombinant tissue plasminogen activator (rt-PA) for eligible patients in acute ischemic stroke (AIS). Using the National Inpatient Sample database, we evaluated trends in treatment with rt-PA and EST for AIS and their outcomes. Methods: This is a cross-sectional observational study of patients with AIS admitted in US hospitals from 2012 to 2016. Patients were grouped into those who received rt-PA alone, EST alone, and rtPA+EST. Survey statistical procedures were performed. Multivariable regression analysis with pairwise comparisons of each treatment group with no treatment group was performed for discharge outcomes. Results: The study included 2,290,520 patients with AIS with the mean age of 70.46 years. Treatment rates increased from 2012 to 2016 for rt-PA by 7% per year (5.86%–7.67%, odds ratio [OR] = 1.07, 95% confidence interval [CI]: 1.05–1.08) and EST by 38% per year (0.55%–1.75%, OR = 1.38, 95% CI: 1.31–1.45) but not rt-PA+EST (0.54%–0.57%, OR = 1.04, 95% CI: 0.99–1.08). The mean length of stay reduced from 2012 to 2016 for rt-PA (6.07–4.91 days, P < 0.0001) and rt-PA+EST (9.19–7.10 days, P = 0.0067) but not for EST (9.61–8.51 days, P = 0.5074). The odds of patients discharged home increased by 8%, 9%, and 15% among patients who received rt-PA alone, EST alone, and rt-PA+EST, respectively, compared with no treatment group. Conclusion: The utilization of rt-PA alone and EST alone increased but that of rt-PA+EST remained unchanged from 2012 to 2016 in the National Inpatient Sample.