Enrollment volume effect on risk factor control and outcomes in the SAMMPRIS trial

David Chiu; Richard P Klucznik; Tanya N Turan; Michael J Lynn; Charles D McCane; Lawrence B Katz; Azhar Nizam; Colin P Derdeyn; David Fiorella; Bethany F Lane; Jean Montgomery; Scott Janis; Marc I Chimowitz

doi:10.1212/WNL.0000000000002191

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Enrollment volume effect on risk factor control and outcomes in the SAMMPRIS trial

Journal article

Open access

Peer reviewed

Enrollment volume effect on risk factor control and outcomes in the SAMMPRIS trial

David Chiu, Richard P Klucznik, Tanya N Turan, Michael J Lynn, Charles D McCane, Lawrence B Katz, Azhar Nizam, Colin P Derdeyn, David Fiorella, Bethany F Lane, …

Neurology, Vol.85(24), pp.2090-2097

12/15/2015

DOI: 10.1212/WNL.0000000000002191

PMCID: PMC4691681

PMID: 26561294

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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.

Brain Ischemia - epidemiology

Stroke - prevention & control

Follow-Up Studies

Humans

Risk Factors

Stroke - diagnosis

Male

Treatment Outcome

Patient Selection

Brain Ischemia - diagnosis

Female

Stroke - epidemiology

Stents

Brain Ischemia - surgery

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.org
Richard 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, MD
Tanya 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, MD
Michael 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, MD
Charles 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, MD
Lawrence 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, MD
Azhar 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, MD
Colin 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, MD
David 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, MD
Bethany 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, MD
Jean 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, MD
Scott 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, MD
Marc 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
DOI: 10.1212/WNL.0000000000002191
PMID: 26561294
PMCID: PMC4691681
NLM abbreviation: Neurology
ISSN: 0028-3878
eISSN: 1526-632X
Publisher: United States
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

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