The effect of time to treatment on outcome in very elderly thrombolysed stroke patients
The effect of time to treatment on outcome in very elderly thrombolysed stroke patients
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DOI：
10.1111/ijs.12249
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发表时间：
2014-07-01
影响因子：
6.7
通讯作者：
Lees, Kennedy R.
中科院分区：
文献类型：
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作者：
Frank, Benedikt;Fulton, Rachael L.;Lees, Kennedy R.
背景静脉溶栓对急性缺血性卒中患者有益，即使是高龄患者。然而，尽管80岁以下患者的治疗获益与治疗延迟（至治疗的起效时间）之间的关系众所周知，但在高龄患者中的关系尚不确定。目的本分析旨在研究老年人的这种关系，并提供一个比较与年轻患者的衍生关系作为有效性检查。方法我们通过分析在试验档案中登记的患者的改良兰金量表评分分布或90天死亡率，评估年龄、治疗开始时间和溶栓暴露之间的相互作用。我们通过在多变量logistic回归模型中将至治疗的起效时间视为连续体，确定阿替普酶的效应是否随至治疗的起效时间而变化。结果3063例患者中有2341例接受了溶栓治疗。597例患者年龄>80岁，其中352例接受了溶栓治疗。在年龄>80岁的患者中，未观察到治疗开始时间与结局的显著相互作用（P=0，中心点4650），但获益随治疗开始时间的衰减的估计斜率与年轻患者的结果相当。分析整个数据集，至治疗发作时间与阿替普酶治疗之间存在相互作用（P=0，中心点0159），但年龄与至治疗发作时间之间（P=0，中心点7098）和年龄与阿替普酶治疗之间（P=0，中心点0755）均无相互作用。结论：在这项非随机比较中，高龄卒中患者从发病到治疗的溶栓治疗的获益和安全性关系与年轻患者相当。在研究的3个中心点5小时的时间跨度内，我们可以安全地使用与年轻患者相同的时间窗进行治疗。
Background Intravenous thrombolysis is beneficial in, even very elderly, acute ischemic stroke patients. However, while the relation between treatment benefit and treatment delay (onset time to treatment) in patients younger than 80 years is well known, it is uncertain in the very elderly. Aims This analysis aims at examining this relationship in the elderly, and to provide a comparison with the derived relationship in younger patients as a check of validity. Methods We assessed the interaction between age, onset time to treatment, and thrombolysis exposure by analyzing the modified Rankin scale score distribution or mortality rate at 90 days, among patients registered in a trials archive. We established whether the effect of alteplase changes with onset time to treatment, by treating onset time to treatment as a continuum in a multivariate logistic regression model. Results Data were available for 3063 patients, of whom 2341 were thrombolysed. Five hundred ninety-seven patients were aged >80, of whom 352 were thrombolysed. Among patients aged >80, no significant interaction of outcome with onset time to treatment was observed (P=0 center dot 4650), but the estimated slope of the decay in benefit with onset time to treatment was comparable with that established for younger patients. Analyzing the entire dataset, there was an interaction between onset time to treatment and alteplase treatment (P=0 center dot 0159), but neither between age and onset time to treatment (P=0 center dot 7098) nor between age and alteplase treatment (P=0 center dot 0755). Conclusions In this nonrandomized comparison, the relationship of benefit and safety with thrombolysis across onset time to treatment in very elderly stroke patients was comparable with that in their younger counterparts. Across the investigated time span of 3 center dot 5h, we can safely treat with the same time window as we use for younger patients.