Asian-American stroke patients had more severe ischemic strokes, were less likely to receive intravenous tissue plasminogen activator (IV tPA), and had worse functional outcomes than white patients, according to a data analysis.
They also had more hemorrhagic complications after receiving tPA, according to the researchers, in a study of of 64,337 Asian-American patients and 1,707,962 white patients admitted for acute ischemic stroke to hospitals participating in the Get With The Guidelines–Stroke (GWTG-Stroke) program from 2004 to 2016.
The study, from Sarah Song, MD, MPH, of Rush University Medical Center in Chicago, and colleagues, was published recently in JAMA Neurology.
After adjusting for patient and hospital variables, the research team suggests that Asian Americans had:
- Greater stroke severity than white patients: NIH Stroke Scale (NIHSS) score ?16 (OR 1.35, 95% CI 1.30-1.40, P<0.001)
- Higher in-hospital mortality (OR 1.14, 95% CI 1.09-1.19, P<0.001), longer length of stay (OR 1.17, 95% CI 1.14-1.20, P<0.001), and less independent ambulation at discharge (OR 0.84, 95% CI 0.79-0.90, P<0.001)
- Fewer IV tPA administrations (OR 0.95, 95% CI 0.91-0.98, P=0.003), but more symptomatic hemorrhage after tPA (OR 1.36, 95% CI 1.20-1.55, P<0.001), and overall post-tPA complications (OR 1.31, 95% CI 1.18-1.46, P<0.001)
“This is just one study, but it’s alarming,” Song says, in a media release from MedPage Today. “Asian Americans are the most rapidly growing ethnic group in the country. This study is a call to action that we need more research in this population.”
Hospitals volunteer to be in the GWTG-Stroke program, and quality of stroke care may be higher than in nonparticipating hospitals, Song and colleagues note in the release. And at baseline, the Asian-American and white cohorts in this study had differences: the white group was older and was more likely to have specific vascular risk factors like atrial fibrillation and coronary artery disease, while the Asian-American group was more likely to have diabetes.
While Asian-American ethnicity in this study encompassed individuals from multiple heritages — Asian, Indian, Chinese, Filipino, Korean, Japanese, Vietnamese, and other groups — information about subgroups was not available. Other limitations of the study included potential residual confounding, which may account for some of the findings. In addition, small differences became statistically significant in this analysis because of the large sample size, possibly inflating the importance of differences between Asian-American and white patients, Song and colleagues add, in the release.
[Source: MedPage Today]