Impact of acute ischemic stroke treatment in patients >80 years of age: the specialized program of translational research in acute stroke (SPOTRIAS) consortium experience.
OBJECTIVE
Few studies have addressed outcomes among patients ≥80 years treated with acute stroke therapy. In this study, we outline in-hospital outcomes in (1) patients ≥80 years compared with their younger counterparts; and (2) those over >80 years receiving intra-arterial therapy (IAT) compared with those treated with intravenous recombinant tissue-type plasminogen activator (IV rtPA).


METHODS
Stroke centers within the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) prospectively collected data on all patients treated with IV rtPA or IAT from January 1, 2005, to December 31, 2010. IAT was defined as receiving any endovascular therapy; IAT was further divided into bridging therapy when the patient received both IAT and IV rtPA and endovascular therapy alone. In-hospital mortality was compared in (1) all patients aged ≥80 years versus younger counterparts; and (2) IAT, bridging therapy, and endovascular therapy alone versus IV rtPA only among those age ≥80 years using multivariable logistic regression. An age-stratified analysis was also performed.


RESULTS
A total of 3768 patients were included in the study; 3378 were treated with IV rtPA alone and 808 with IAT (383 with endovascular therapy alone and 425 with bridging therapy). Patients ≥80 years (n=1182) had a higher risk of in-hospital mortality compared with younger counterparts regardless of treatment modality (OR, 2.13; 95% CI, 1.60-2.84). When limited to those aged ≥80 years, IAT (OR, 0.95; 95% CI, 0.60-1.49), bridging therapy (OR, 0.82; 95% CI, 0.47-1.45), or endovascular therapy alone (OR, 1.15; 95% CI, 0.64-2.08) versus IV rtPA were not associated with increased in-hospital mortality.


CONCLUSIONS
IAT does not appear to increase the risk of in-hospital mortality among those aged >80 years compared with IV thrombolysis alone.
Department of Neurology, 710 West 168 Street, Box 30, New York, NY 10032, USA. jzw2@columbia.edu
Joshua Z
JZ
Willey
Santiago
S
Ortega-Gutierrez
Nils
N
Petersen
Pooja
P
Khatri
Andria L
AL
Ford
Natalia S
NS
Rost
Latisha K
LK
Ali
Nichole R
NR
Gonzales
Jose G
JG
Merino
Brett C
BC
Meyer
Randolph S
RS
Marshall
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over / Q000706:statistics & numerical data*; D002545:Brain Ischemia / Q000401:mortality / Q000628:therapy*; D003627:Data Interpretation, Statistical; D057510:Endovascular Procedures; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D057170:Translational Research, Biomedical
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator