From the Department of Clinical Neuroscience, King's College London, United Kingdom (D.M., S.B., L.K.); and Acute and Emergency Medicine, King's College Hospital NHS Trust, London, United Kingdom (D.M., J.K.).
Stroke. 2013 Oct;44(10):2898-900. doi: 10.1161/STROKEAHA.113.002273. Epub 2013 Aug 1.
Thrombolysis in patients >80 years remains controversial; we hypothesized that >80-year-old patients with wake-up ischemic stroke (WUIS) will benefit from thrombolysis despite risks because of poor outcomes with no treatment.
The study included 68 thrombolysed patients with WUIS (33 [48%] >80 years), 54 nonthrombolysed patients with WUIS (21 [39%] >80 years), and 117 patients (>80 years old) thrombolysed within 4.5 hours of symptom onset (reference group). Mortality and modified Rankin Scale (mRS) were assessed at 90 days.
Baseline characteristics of thrombolysed and nonthrombolysed >80 and ≤80-year-old patients with WUIS were comparable. Thrombolysis outcomes in >80-year-old patients with WUIS were better than in nonthrombolysed >80-year-old patients with WUIS (90-day mortality: 24% versus 47%, P=0.034; mRS 0-2: 30% versus 5%, P=0.023; mRS 0-1: 15% versus 5%, P=0.24) and comparable with thrombolysed ≤80-year-old patients with WUIS. Thrombolysis was associated with odds ratio 0.27 (95% confidence interval, 0.05-0.97) for mortality and odds ratio 28.6 (95% confidence interval, 1.8-448) for mRS 0 to 2 at 90 days in >80-year-old patients with WUIS after adjusting for stroke severity and risk factors.
Thrombolysis may be associated with greater benefit in >80-year-old patients with WUIS but a selection bias favoring thrombolysis in those most likely to benefit may significantly reduce interpretability of these findings.
超过 80 岁的患者进行溶栓治疗仍存在争议；我们假设，尽管治疗后结果不佳，但由于没有治疗，醒来时发生缺血性脑卒中（WUIS）的 >80 岁患者仍将从溶栓治疗中获益。
本研究纳入了 68 例接受溶栓治疗的 WUIS 患者（33 例[48%]年龄>80 岁）、54 例未接受溶栓治疗的 WUIS 患者（21 例[39%]年龄>80 岁）和 117 例在症状发作后 4.5 小时内接受溶栓治疗的（>80 岁）患者（参考组）。在 90 天时评估死亡率和改良 Rankin 量表（mRS）评分。
接受溶栓治疗和未接受溶栓治疗的>80 岁和≤80 岁 WUIS 患者的基线特征相似。WUIS 中>80 岁患者溶栓治疗的结局优于未接受溶栓治疗的>80 岁患者（90 天死亡率：24%比 47%，P=0.034；mRS 0-2：30%比 5%，P=0.023；mRS 0-1：15%比 5%，P=0.24），且与接受溶栓治疗的≤80 岁 WUIS 患者相似。在校正了卒中严重程度和危险因素后，WUIS 中>80 岁患者溶栓治疗与 90 天死亡率的比值比为 0.27（95%可信区间，0.05-0.97），与 mRS 0-2 的比值比为 28.6（95%可信区间，1.8-448）。
对于 WUIS 的>80 岁患者，溶栓治疗可能带来更大的获益，但存在偏向最有可能获益的患者选择溶栓治疗的偏倚，这可能大大降低对这些发现的解释能力。
