Journal article
Enrollment volume effect on risk factor control and outcomes in the SAMMPRIS trial
Neurology, Vol.85(24), pp.2090-2097
12/15/2015
DOI: 10.1212/WNL.0000000000002191
PMCID: PMC4691681
PMID: 26561294
Abstract
The role of physician experience and patient volumes on the outcome of surgical or endovascular procedures has been well-studied but there are limited data on how these factors affect the outcome of medical therapy.
In the stenting and medical cohorts of the Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke (SAMMPRIS) trial, we compared Kaplan-Meier (K-M) curves for the primary endpoint (any stroke or death within 30 days of enrollment or ischemic stroke in the territory beyond 30 days) using the log-rank test and the percentages of patients achieving target levels for primary and secondary risk factors during the study using Fisher exact test between patients at high-enrolling (≥12 patients) vs low-enrolling (<12 patients) sites.
In the stenting group, the K-M curves for the primary endpoint were similar at high-enrolling sites and low-enrolling sites (p = 0.93) with rates of 13.5% vs 14.7% at 30 days and 19.0% vs 20.6% at 2 years. In the medical group, the K-M curves differed between high-enrolling sites and low-enrolling sites (p = 0.0005) with rates of 1.8% vs 9.8% at 30 days and 7.3% vs 20.9% at 2 years. The percentages of patients who achieved targets for low-density lipoprotein cholesterol and systolic blood pressure at high- vs low-enrolling sites in both treatment groups combined were 64% vs 49% (p = 0.003) and 70% vs 59% (p = 0.026), respectively.
High-enrolling sites in SAMMPRIS achieved better control of primary risk factors and much lower rates of the primary endpoint than low-enrolling sites in the medical group, suggesting that experience with medical management is an important determinant of patient outcome.
Details
- Title: Subtitle
- Enrollment volume effect on risk factor control and outcomes in the SAMMPRIS trial
- Creators
- David Chiu - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MD. dchiu@tmhs.orgRichard P Klucznik - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MDTanya N Turan - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MDMichael J Lynn - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MDCharles D McCane - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MDLawrence B Katz - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MDAzhar Nizam - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MDColin P Derdeyn - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MDDavid Fiorella - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MDBethany F Lane - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MDJean Montgomery - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MDScott Janis - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MDMarc I Chimowitz - From Houston Methodist Hospital (D.C., R.P.K., C.D.M., L.B.K.), Weill Cornell Medical College, TX; Medical University of South Carolina (T.N.T., M.I.C.), Charleston; Emory University Rollins School of Public Health (M.J.L., A.N., B.F.L., J.M.), Atlanta, GA; Washington University School of Medicine (C.P.D.), St Louis, MO; State University of New York (D.F.), Stony Brook; and National Institute of Neurological Disorders and Stroke (S.J.), National Institute of Health, Bethesda, MD
- Resource Type
- Journal article
- Publication Details
- Neurology, Vol.85(24), pp.2090-2097
- Publisher
- United States
- DOI
- 10.1212/WNL.0000000000002191
- PMID
- 26561294
- PMCID
- PMC4691681
- ISSN
- 0028-3878
- eISSN
- 1526-632X
- Grant note
- UL1RR029890 / NCRR NIH HHS U01 NS058728 / NINDS NIH HHS UL1RR029882 / NCRR NIH HHS K23 NS069668 / NINDS NIH HHS UL1RR029889 / NCRR NIH HHS UL1RR024131 / NCRR NIH HHS
- Language
- English
- Date published
- 12/15/2015
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020785702771
Metrics
35 Record Views