Impact of acute ischemic stroke treatment in patients >80 years of age: the specialized program of translational research in acute stroke (SPOTRIAS) consortium experience.
Impact of acute ischemic stroke treatment in patients >80 years of age: the specialized program of translational research in acute stroke (SPOTRIAS) consortium experience.
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DOI：
10.1161/strokeaha.112.660993
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发表时间：
2012-09
期刊：
影响因子：
8.3
通讯作者：
Marshall RS
中科院分区：
文献类型：
--
作者：
Willey JZ;Ortega-Gutierrez S;Petersen N;Khatri P;Ford AL;Rost NS;Ali LK;Gonzales NR;Merino JG;Meyer BC;Marshall RS
很少有研究探讨接受急性卒中治疗的 80 岁以上患者的结局。在这项研究中，我们概述了 (1) ≥80 岁患者与年轻患者的院内结局，(2) 80 岁以上接受动脉内治疗 (IAT) 的患者与静脉注射重组组织纤溶酶原激活剂 (IVrtPA) 治疗的患者相比。急性卒中转化研究专门计划 (SPOTRIAS) 中的卒中中心前瞻性地收集了 2005 年 1 月 1 日至 2010 年 12 月 31 日期间接受 IVrtPA 或 IAT 治疗的所有患者的数据。 IAT被定义为接受任何血管内治疗； IAT进一步分为桥接治疗（BT）（当患者同时接受IAT和IVrtPA时）和单独血管内治疗（ETA）。使用多变量逻辑回归比较了以下方面的院内死亡率：(1) 所有年龄≥80 岁的患者与年轻患者的比较；(2) 仅在年龄≥80 岁的患者中使用 IAT、BT 和 ETA 与 IVrtPA 进行比较。还进行了年龄分层分析。该研究总共纳入了 3768 名患者； 3378 人接受单独 IVrtPA 治疗，808 人接受 IAT 治疗（383 人接受 ETA，425 人接受 BT）。无论治疗方式如何，≥80 岁的患者 (n=1182) 与年轻患者相比，院内死亡风险较高（OR 2.13，95%CI 1.60–2.84）。当仅限于年龄≥80岁的患者时，与 IVrtPA 相比，IAT（OR 0.95，95%CI 0.60–1.49）、BT（OR 0.82，95%CI 0.47–1.45）或 ETA（OR 1.15，95%CI 0.64–2.08）与 IVrtPA 相比，与院内死亡率增加无关，IAT 似乎不会增加院内死亡率增加的风险。与单独静脉溶栓相比，80 岁以上患者的院内死亡率。
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 to their younger counterparts, and (2) those over age 80 receiving intra-arterial therapy (IAT) compared to those treated with intravenous recombinant tissue plasminogen activator (IVrtPA). Stroke centers within the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) prospectively collected data on all patients treated with IVrtPA or IAT from 1/1/2005 to 12/31/2010. IAT was defined as receiving any endovascular therapy; IAT was further divided into bridging therapy (BT) when the patient received both IAT and IVrtPA, and endovascular therapy alone (ETA). In-hospital mortality was compared in (1) all patients age ≥80 versus younger counter-parts, and (2) IAT, BT, and ETA versus IVrtPA only among those age ≥80 using multivariable logistic regression. An age-stratified analysis was also performed. A total of 3768 patients were included in the study; 3378 were treated with IVrtPA alone, 808 with IAT (383 with ETA and 425 with BT). Patients ≥80 (n=1182) had a higher risk of in-hospital mortality compared to younger counterparts regardless of treatment modality (OR 2.13, 95%CI 1.60–2.84). When limited to those age ≥80, IAT (OR 0.95, 95%CI 0.60–1.49), BT (OR 0.82, 95%CI 0.47–1.45), or ETA (OR 1.15, 95%CI 0.64–2.08) versus IVrtPA were not associated with increased in-hospital mortality IAT does not appear to increase the risk of in-hospital mortality among those over age 80 compared to intravenous thrombolysis alone.