Abstract DP208: Acute Reperfusion Therapy in American Indians, Alaska Native People, and Native Hawaiian/Pacific Islanders with Acute Ischemic Stroke.

Introduction: Limited data exist on reperfusion therapy in acute ischemic stroke among Indigenous Americans, including American Indians (AI), Alaska Natives (AN), Native Hawaiian (NH) and Pacific Islanders (PI). We examined use, safety, and outcomes of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) in AI/AN and NH/PI compared to non-Indigenous patients with acute ischemic stroke. Methods: Retrospective analysis of adult patients with acute ischemic stroke admitted to hospitals participating in the AHA/ASA Get With The Guidelines-Stroke prospective quality improvement registry (January 1, 2015-December 31, 2023). Generalized linear mixed models assessed associations between Indigenous status and both reperfusion therapy and outcomes. Results: Among 1,456,791 patients (median age 70 years, 48.7% female), 21,495 were Indigenous (13,606 AI/AN, 7889 NH/PI) and 1,435,296 were non-Indigenous, admitted to 489 hospitals. Indigenous patients were 5-6 years younger, had similar stroke severity, and were more likely to present to rural hospitals, than non-Indigenous patients. After adjustment for patient and hospital variables, IVT rates, including timeliness of therapy, were comparable across groups (Table 1). AI/AN had lower EVT rates (odds ratio [OR]=0.76, 95% confidence interval [CI] 0.69-0.82, p<0.0001), while NH/PI rates were similar to non-Indigenous patients. AI/AN had greater in-hospital mortality (OR=1.10, 95% CI 1.01-1.20, p=0.025), but greater odds of discharge home (OR=1.08, 95% CI 1.04-1.12, p=0.0002) than non-Indigenous patients. NH/PI had similar mortality, but longer hospital stays (OR=1.06, 95% CI 1.01-1.12, p=0.0244), than non-Indigenous patients. Rates of symptomatic intracranial hemorrhage and life-threatening systemic hemorrhage after reperfusion therapy were similar between Indigenous and non-Indigenous patients. Conclusions: In this largest study of its kind, Indigenous patients received IVT at similar rates and timing, but AI/AN had lower rates of EVT compared to non-Indigenous patients. While safety of IVT/EVT was similar, AI/AN had higher mortality, and NH/PI had longer hospital stays, than non-Indigenous patients. These findings highlight opportunities for targeted quality improvement initiatives and emphasize the importance of analyzing different Indigenous groups separately in stroke research.