Neurology Department, University Hospital of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland.
Stroke. 2011 Jul;42(7):1967-70. doi: 10.1161/STROKEAHA.110.601252. Epub 2011 May 19.
Demographic changes will result in a rapid increase of patients age ≥90 years (nonagenarians), but little is known about outcomes in these patients after intravenous thrombolysis (IVT) for acute ischemic stroke. We aimed to assess safety and functional outcome in nonagenarians treated with IVT and to compare the outcomes with those of patients age 80 to 89 years (octogenarians).
We analyzed prospectively collected data of 284 consecutive stroke patients age ≥80 years treated with IVT in 7 Swiss stroke units. Presenting characteristics, favorable outcome (modified Rankin scale [mRS] 0 or 1), mortality at 3 months, and symptomatic intracranial hemorrhage (SICH) using the National Institute of Neurological Disorders and Stroke (NINDS) and Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria were compared between nonagenarians and octogenarians.
As compared with octogenarians (n=238; mean age, 83 years), nonagenarians (n=46; mean age, 92 years) were more often women (70% versus 54%; P=0.046) and had lower systolic blood pressure (161 mm Hg versus 172 mm Hg; P=0.035). Patients age ≥90 years less often had a favorable outcome and had a higher incidence of mortality than did patients age 80 to 89 years (14.3% versus 30.2%; P=0.034; and 45.2% versus 22.1%; P=0.002; respectively), while more nonagenarians than octogenarians experienced a SICH (SICH(NINDS), 13.3% versus 5.9%; P=0.106; SICH(SITS-MOST), 13.3% versus 4.7%; P=0.037). Multivariate adjustment identified age ≥90 years as an independent predictor of mortality (P=0.017).
Our study suggests less favorable outcomes in nonagenarians as compared with octogenarians after IVT for ischemic stroke, and it demands a careful selection for treatment, unless randomized controlled trials yield more evidence for IVT in very old stroke patients.
人口结构变化将导致 90 岁以上（非 90 岁）患者数量迅速增加，但关于这些患者接受静脉溶栓（IVT）治疗急性缺血性卒中的结局知之甚少。我们旨在评估非 90 岁患者接受 IVT 的安全性和功能结局，并将其与 80 至 89 岁患者（80 岁组）的结局进行比较。
我们分析了 7 家瑞士卒中单位 284 例连续接受 IVT 治疗的年龄≥80 岁卒中患者的前瞻性采集数据。比较非 90 岁组和 80 岁组患者的基线特征、结局（改良 Rankin 量表[mRS]0 或 1 分）、3 个月死亡率和症状性颅内出血（SICH）[采用国立神经疾病与卒中研究所（NINDS）和溶栓治疗监测研究-安全实施（SITS-MOST）标准]。
与 80 岁组（n=238；平均年龄 83 岁）相比，90 岁组（n=46；平均年龄 92 岁）患者中女性更多（70% vs. 54%；P=0.046），收缩压更低（161mmHg vs. 172mmHg；P=0.035）。与 80 至 89 岁患者相比，90 岁以上患者结局更好的比例较低，死亡率更高（14.3% vs. 30.2%；P=0.034；45.2% vs. 22.1%；P=0.002），非 90 岁组 SICH 发生率高于 80 岁组（SICH（NINDS），13.3% vs. 5.9%；P=0.106；SICH（SITS-MOST），13.3% vs. 4.7%；P=0.037）。多变量调整后，年龄≥90 岁是死亡率的独立预测因素（P=0.017）。
与 80 至 89 岁患者相比，IVT 治疗缺血性卒中的非 90 岁患者结局更差，除非随机对照试验为老年卒中患者提供更多 IVT 证据，否则应慎重选择治疗。
