Nagaraja Nandakumar, Patel Urvish K, Chaturvedi Seemant
Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
Department of Neurology and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Neurol Sci. 2021 Jan 15;420:117262. doi: 10.1016/j.jns.2020.117262. Epub 2020 Dec 7.
U.S. demographics is shifting towards older population. Older stroke patients likely receive less tissue-plasminogen activator (t-PA) and mechanical thrombectomy (MT) compared to younger patients. The objective of this study is to evaluate extent of difference in utilization of t-PA and MT and outcomes of stroke between three age groups -18-45 (young adults), 46-80 (middle/old), and > 80 (oldest old) years.
It is a retrospective cross-sectional observational study. Primary outcomes were rates of stroke intervention and effect of age on stroke intervention. Secondary outcomes were in-hospital mortality, discharge to home, and prolonged length of stay. Multivariate survey-logistic regression was performed to evaluate outcomes.
Among 487,105 patients in the study 4.8% were young adults, 66.6% middle/old, and 28.6% oldest old. Compared to young adults, middle/old received 19% (OR = 0.81; 95%CI = 0.72-0.91) less t-PA alone; and 33% (OR = 0.67; 95%CI = 0.53-0.83) less MT alone; oldest old received 25% less t-PA alone (OR = 0.75; 95%CI = 0.66-0.86) and 51% (OR = 0.49; 95%CI = 0.38-0.63) less MT alone. Compared to young adults, in-hospital mortality was three-fold higher among middle/old (OR = 3.5; 95%CI = 1.3-9.6), and seven-fold higher among oldest old (OR = 7.5; 95%CI = 2.8-20.5) for t-PA alone; discharge to home reduced by 40% in middle/old (OR = 0.6; 95%CI = 0.4-0.7) and by 80% in oldest old (OR = 0.2; 95%CI = 0.1-0.2) for t-PA alone and similarly for MT alone.
Oldest old receive one-fourth less t-PA and half less MT compared to young adults. Oldest old patients who received t-PA alone or MT alone had remarkably worse outcomes for in-hospital mortality and discharge to home than young adults did.
美国人口结构正朝着老龄化转变。与年轻患者相比，老年卒中患者可能接受的组织型纤溶酶原激活剂（t-PA）和机械取栓术（MT）较少。本研究的目的是评估三个年龄组（18 - 45岁（青年）、46 - 80岁（中老年）和80岁以上（高龄））在t-PA和MT使用情况以及卒中结局方面的差异程度。
这是一项回顾性横断面观察研究。主要结局是卒中干预率以及年龄对卒中干预的影响。次要结局是住院死亡率、出院回家情况以及住院时间延长情况。采用多变量调查逻辑回归来评估结局。
在该研究的487,105名患者中，4.8%为青年，66.6%为中老年，28.6%为高龄。与青年相比，中老年单独接受t-PA治疗的比例低19%（OR = 0.81；95%CI = 0.72 - 0.91）；单独接受MT治疗的比例低33%（OR = 0.67；95%CI = 0.53 - 0.83）；高龄单独接受t-PA治疗的比例低25%（OR = 0.75；95%CI = 0.66 - 0.86），单独接受MT治疗的比例低51%（OR = 0.49；95%CI = 0.38 - 0.63）。与青年相比，仅接受t-PA治疗时，中老年的住院死亡率高出三倍（OR = 3.5；95%CI = 1.3 - 9.6），高龄高出七倍（OR = 7.5；95%CI = 2.8 - 20.5）；仅接受t-PA治疗时，中老年出院回家的比例降低40%（OR = 0.6；95%CI = 0.4 - 0.7），高龄降低80%（OR = 0.2；95%CI = 0.1 - 0.2），MT治疗时情况类似。
与青年相比，高龄接受的t-PA治疗少四分之一，MT治疗少一半。仅接受t-PA或MT治疗的高龄患者在住院死亡率和出院回家方面的结局明显比青年患者差。
