Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
Stroke Unit, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
Intern Emerg Med. 2021 Jan;16(1):101-108. doi: 10.1007/s11739-020-02318-y. Epub 2020 Apr 4.
The benefits and risks of acute reperfusion therapy (RT) in acute ischaemic stroke (AIS) remain uncertain in older patients, especially in nonagenarians. We aimed to assess the impact of RT in this population. Single-center retrospective cohort study comparing patients ≥ 90 years old admitted to a Stroke Unit (2008-2018) with AIS, submitted or not to RT [intravenous thrombolysis(IVT), mechanical thrombectomy(MT) or both]. Baseline characteristics, in-hospital complications and 3-month outcomes were compared. The primary outcome was 3-month "favorable outcome", defined as modified Rankin Scale score 0-2 or equal to pre-stroke. Secondary outcomes were haemorrhagic transformation (HT) and 3 months mortality. We included 167 patients (median age 92 years, 66.5% females); 46.1% underwent RT (59 IVT, 11 MT, 7 both). RT group had higher admission National Institutes of Health Stroke Scale (NIHSS) (16 versus 9.5, p < 0.001). Favorable outcome occurred in only 22% of patients, with no differences between groups; its odds decreased with higher NIHSS scores (OR 0.80, 95%CI 0.73-0.87, p < 0.001) and with the development of in-hospital respiratory infection (OR 0.22, 95%CI 0.07-0.67, p = 0.007). HT occurred in 16.2% of patients, being more prevalent (26.0% versus 7.8%, p = 0.001), symptomatic (14.3% versus 3.3%, p = 0.011) and severe (PH1/2 15.6% versus 2.2%, p = 0.012) in the RT group, although it did not influence the primary outcome. Mortality was 32% at 3 months, with no difference between groups. Although patients submitted to RT had worse admission NIHSS and increased HT, they had similar functional outcome at 3 months. Stroke severity and in-hospital respiratory infections were the most important predictors of 3 months' functional outcome.
急性再灌注治疗（RT）在急性缺血性脑卒中（AIS）老年患者中的获益和风险仍不确定，尤其是在 90 岁以上的患者中。我们旨在评估该人群中 RT 的影响。这项单中心回顾性队列研究比较了 2008 年至 2018 年入住卒中单元的年龄≥90 岁的 AIS 患者，分为接受 RT [静脉溶栓（IVT）、机械取栓（MT）或两者均接受]和未接受 RT 两组。比较了两组的基线特征、住院并发症和 3 个月的结局。主要结局为 3 个月时的“良好结局”，定义为改良 Rankin 量表评分 0-2 或等于发病前。次要结局为出血性转化（HT）和 3 个月死亡率。共纳入 167 例患者（中位年龄 92 岁，66.5%为女性）；46.1%接受了 RT（59 例 IVT，11 例 MT，7 例两者均接受）。RT 组入院时国立卫生研究院卒中量表（NIHSS）评分更高（16 分 vs 9.5 分，p<0.001）。仅有 22%的患者获得良好结局，两组间无差异；良好结局的可能性随 NIHSS 评分升高而降低（OR 0.80，95%CI 0.73-0.87，p<0.001），且与住院期间发生呼吸道感染有关（OR 0.22，95%CI 0.07-0.67，p=0.007）。16.2%的患者发生 HT，RT 组更常见（26.0% vs 7.8%，p=0.001）、症状性（14.3% vs 3.3%，p=0.011）和严重（PH1/2 15.6% vs 2.2%，p=0.012），但对主要结局无影响。3 个月死亡率为 32%，两组间无差异。尽管接受 RT 的患者入院 NIHSS 评分较差且 HT 发生率较高，但 3 个月时的功能结局相似。卒中严重程度和住院期间的呼吸道感染是 3 个月功能结局的最重要预测因素。
