Thrombolysis in very elderly people: controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive.
Thrombolysis in very elderly people: controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive.
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DOI：
10.1136/bmj.c6046
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发表时间：
2010-11-23
期刊：
影响因子：
--
通讯作者：
SITS collaborators
中科院分区：
文献类型：
--
作者：
Mishra NK;Ahmed N;Andersen G;Egido JA;Lindsberg PJ;Ringleb PA;Wahlgren NG;Lees KR;VISTA collaborators;SITS collaborators
目的探讨急性缺血性脑卒中患者年龄对阿替普酶疗效的影响。设计：对接受或未接受溶栓治疗的非随机患者的结果进行调整对照比较。分析采用Cochran-Mantel-Haenszel检验和比例odds logistic回归分析。设置国际脑卒中溶栓登记（SITS-ISTR）和虚拟国际脑卒中试验档案（VISTA）之间的合作。参与者：23334例SITS-ISTR患者（2002年12月至2009年11月）接受了溶栓治疗，6166例来自VISTA神经保护试验（1998-2007年）未接受溶栓治疗（作为对照）。在29500名患者中（3472名年龄在80岁至80岁之间，平均84.6岁），272名患者的数据在美国国立卫生研究院卒中严重程度评分中缺失，剩下29228名患者根据年龄和基线严重程度进行了调整。主要结局指标：90天功能结局采用改良Rankin量表评分。结果溶栓组和对照组的基线中位严重程度相同（每组基线中位卒中评分为12分，P=0.14; n=29 228）。改良Rankin量表评分在溶栓患者中的分布优于对照组（优势比1.6,95%可信区间1.5 ~ 1.7;Cochran-Mantel-Haenszel P<0.001）。年龄≤80岁的患者（1.6,1.5 ~ 1.7；P<0.001; n=25 789）和年龄≤80岁的患者（1.4,1.3 ~ 1.6；P<0.001; n=3439）独立存在相关性。比值比在30岁以上的所有10岁年龄段都是一致的，从41岁到90岁的获益显著；二分类结果（修改Rankin量表评分0-1 v 2-6； 0-2 v 3-6; 6（死亡）v休息）与顺序分析结果一致。结论：急性缺血性脑卒中患者接受溶栓治疗的预后明显优于未接受溶栓治疗的预后。年龄增加与预后较差相关，但溶栓治疗与预后改善之间的关联在高龄患者中仍然存在。年龄本身不应成为治疗的障碍。
Objective To assess effect of age on response to alteplase in acute ischaemic stroke. Design Adjusted controlled comparison of outcomes between non-randomised patients who did or did not undergo thrombolysis. Analysis used Cochran-Mantel-Haenszel test and proportional odds logistic regression analysis. Setting Collaboration between International Stroke Thrombolysis Registry (SITS-ISTR) and Virtual International Stroke Trials Archive (VISTA). Participants 23 334 patients from SITS-ISTR (December 2002 to November 2009) who underwent thrombolysis and 6166 from VISTA neuroprotection trials (1998-2007) who did not undergo thrombolysis (as controls). Of the 29 500 patients (3472 aged >80 (“elderly,” mean 84.6), data on 272 patients were missing for baseline National Institutes of Health stroke severity score, leaving 29 228 patients for analysis adjusted for age and baseline severity. Main outcome measures Functional outcomes at 90 days measured by score on modified Rankin scale. Results Median severity at baseline was the same for patients who underwent thrombolysis and controls (median baseline stroke scale score: 12 for each group, P=0.14; n=29 228). The distribution of scores on the modified Rankin scale was better among all thrombolysis patients than controls (odds ratio 1.6, 95% confidence interval 1.5 to 1.7; Cochran-Mantel-Haenszel P<0.001). The association occurred independently among patients aged ≤80 (1.6, 1.5 to 1.7; P<0.001; n=25 789) and in those aged >80 (1.4, 1.3 to 1.6; P<0.001; n=3439). Odds ratios were consistent across all 10 year age ranges above 30, and benefit was significant from age 41 to 90; dichotomised outcomes (score on modified Rankin scale 0-1 v 2-6; 0-2 v 3-6; and 6 (death) v rest) were consistent with the results of the ordinal analysis. Conclusions Outcome in patients with acute ischaemic stroke is significantly better in those who undergo thrombolysis compared with those who do not. Increasing age is associated with poorer outcome but the association between thrombolysis treatment and improved outcome is maintained in very elderly people. Age alone should not be a barrier to treatment.
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影响因子：
8.3
作者：
Bath, Philip M. W.
通讯作者：
Bath, Philip M. W.
影响因子：
9.9
作者：
Engelter, ST;Reichhart, M;Lyrer, PA
通讯作者：
Lyrer, PA
影响因子：
8.3
作者：
Bath, Philip;Gray, Laura J.;Collier, Timothy
通讯作者：
Collier, Timothy
影响因子：
8.3
作者：
Ali, Myzoon;Bath, Philip M. W.;Lees, Kennedy R.
通讯作者：
Lees, Kennedy R.
影响因子：
48
作者：
Ahmed, Niaz;Wahlgren, Nils;Ringleb, Peter
通讯作者：
Ringleb, Peter