Department of Neurology, 710 West 168 Street, Box 30, New York, NY 10032, USA.
Stroke. 2012 Sep;43(9):2369-75. doi: 10.1161/STROKEAHA.112.660993. Epub 2012 Jul 12.
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).
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.
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.
IAT does not appear to increase the risk of in-hospital mortality among those aged >80 years compared with IV thrombolysis alone.
很少有研究关注接受急性卒中治疗的≥80 岁患者的结局。本研究旨在阐述（1）≥80 岁患者与年轻患者相比的院内结局；以及（2）>80 岁患者接受动脉内治疗（IAT）与接受静脉内重组组织型纤溶酶原激活剂（IV rtPA）治疗相比的院内结局。
专门的急性卒中转化研究计划（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 日期间所有接受 IV rtPA 或 IAT 治疗的患者的数据。IAT 定义为接受任何血管内治疗；IAT 进一步分为桥接治疗，当患者接受 IAT 和 IV rtPA 联合治疗以及单纯血管内治疗时。采用多变量逻辑回归比较（1）所有≥80 岁的患者与年轻患者相比的院内死亡率；以及（2）≥80 岁患者中 IAT、桥接治疗和单纯血管内治疗与 IV rtPA 仅用于治疗的患者相比的院内死亡率。还进行了年龄分层分析。
共纳入 3768 例患者，其中 3378 例患者单独接受 IV rtPA 治疗，808 例患者接受 IAT 治疗（383 例患者单独接受血管内治疗，425 例患者接受桥接治疗）。与年轻患者相比，无论治疗方式如何，≥80 岁的患者（OR，2.13；95%CI，1.60-2.84）的院内死亡率更高。当仅限于≥80 岁的患者时，IAT（OR，0.95；95%CI，0.60-1.49）、桥接治疗（OR，0.82；95%CI，0.47-1.45）或单纯血管内治疗（OR，1.15；95%CI，0.64-2.08）与 IV rtPA 相比，并未增加院内死亡率。
与单独 IV 溶栓相比，IAT 似乎不会增加≥80 岁患者的院内死亡率。
