RCT versus real-world cohorts: Differences in patient characteristics drive associations with outcome after EVT.

Background

The selection of patients with large-vessel occlusion (LVO) stroke for endovascular treatment (EVT) depends on patient characteristics and procedural metrics. The relation of these variables to functional outcome after EVT has been assessed in numerous datasets from both randomized controlled trials (RCT) and real-world registries, but whether differences in their case mix modulate outcome prediction is unknown.

Methods

We leveraged data from individual patients with anterior LVO stroke treated with EVT from completed RCTs from the Virtual International Stroke Trials Archive (

Results

Ten out of 11 analyzed baseline variables differed between the RCT and real-world cohort: RCT patients were younger, had higher admission NIHSS scores, and received thrombolysis more often (all

Conclusions

RCT and real-world cohorts considerably differ in patient characteristics, individual outcome predictor strength, and overall outcome prediction model performance.

Informations de copyright

© European Stroke Organisation 2022.

Déclaration de conflit d'intérêts

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LK has received funding for travel or speaker honoraria from Bayer Vital, Boehringer Ingelheim, Bristol-Meyer-Squibb, Daiichi Sankyo, and Pfizer outside of this study. MG reports personal fees from Medtronic, Stryker, Microvention, and Mentice, all outside the submitted work. In addition, MG has a patent on “Systems of acute stroke diagnosis” licensed to GE Healthcare, and a patent on “Systems of intracranial access” licensed to Microvention. CG reports personal fees from Amgen, Boehringer Ingelheim, Daiichi Sankyo, Abbott, Prediction Biosciences, Novartis, and Bayer, all outside the submitted work. GT reports grants and personal fees from Bayer, and personal fees from Acandis, BristolMyersSquibb/Pfizer, Boehringer Ingelheim, Daiichi Sankyo, Portola, and Stryker, all outside the submitted work. ST reports personal fees from Apollo Alpha, outside of the submitted work. All other authors declare no competing interests.