Sudre Justine, Venditti Laura, Ancelet Claire, Chassin Olivier, Sarov Mariana, Smadja Didier, Chausson Nicolas, Lun François, Laine Olga, Duron Emmanuelle, Verny Christiane, Spelle Laurent, Rouquette Alexandra, Legris Nicolas, Denier Christian
Department of Neurology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, Le Kremlin Bicêtre, France.
Neuroradiology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, Le Kremlin Bicêtre, France.
J Am Geriatr Soc. 2021 Nov;69(11):3167-3176. doi: 10.1111/jgs.17394. Epub 2021 Aug 10.
While randomized clinical trials have shown the benefit of thrombolysis and endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS), we aimed to describe in a real-life study the differences between older (>80 years old) and younger patients treated for AIS.
Thousand patients treated with thrombolysis and/or EVT were consecutively included in a prospective monocentric database (admitted from December 2015 to May 2019 in our comprehensive stroke center). Demographic data with detailed history, baseline physical examinations and treatments, laboratory and imaging data, prestroke functional status, and outcome 3 months after stroke were analyzed.
Older patients (n = 357) had more baseline comorbidities and lower levels of prestroke independence (modified Rankin scale ≤2; 67.2% vs. 96.1%) and more severe strokes (median National Institute of Health Stroke Score [NIHSS] 15 vs. 12; p < 0.001) than younger patients (n = 643). There was no difference in the reperfusion treatments used or treatment timelines. In older patients, good functional status at 3 months was less common (29.7% vs. 61.3%) and mortality was higher (37.1% vs. 11.4%) than in younger patients. Younger age was independently associated with better prognosis (odds ratio [OR] 0.37, 95% confidence interval [CI]: 0.20-0.67; p = 0.001) and lower mortality (OR 4.38, 95% CI: 2.11-9.09; p < 0.001). Among older adults, features associated with good outcome at 3 months were age (OR 0.89, 95% CI: 0.81-0.97; p = 0.01), initial NIHSS (OR 0.89, 95% CI: 0.83-0.94; p < 0.0001), and absence of severe leukoaraiosis, anticoagulant treatment, and symptomatic intracerebral hemorrhage following reperfusion therapy (respectively, OR 0.42, 95% CI: 0.19-0.93; p = 0.03; OR = 0.07, 95% CI: 0.01-0.70; p = 0.02; and OR = 0.07, 95% CI: 0.01-0.61; p = 0.02).
Although reperfusion therapy was less successful in older patients, these patients may benefit from acute recanalization despite their age. With an increasing older adult population, high-quality prospective studies are still required to better predict functional outcome and clarify the criteria that would allow better selection of appropriate treatment.
虽然随机临床试验已证明溶栓和血管内血栓切除术（EVT）对急性缺血性卒中（AIS）患者有益，但我们旨在通过一项现实生活研究描述接受AIS治疗的老年（>80岁）和年轻患者之间的差异。
1000例接受溶栓和/或EVT治疗的患者连续纳入一个前瞻性单中心数据库（2015年12月至2019年5月在我们的综合卒中中心入院）。分析了人口统计学数据、详细病史、基线体格检查和治疗、实验室和影像学数据、卒中前功能状态以及卒中后3个月的结局。
老年患者（n = 357）比年轻患者（n = 643）有更多的基线合并症，卒中前独立水平更低（改良Rankin量表≤2；67.2%对96.1%），且卒中更严重（美国国立卫生研究院卒中量表[NIHSS]中位数15对12；p < 0.001）。所使用的再灌注治疗或治疗时间线没有差异。与年轻患者相比，老年患者3个月时良好功能状态的情况较少见（29.7%对61.3%），死亡率更高（37.1%对11.4%）。年轻是预后较好（优势比[OR]0.37，95%置信区间[CI]：0.20 - 0.67；p = 0.001）和死亡率较低（OR 4.38，95% CI：2.11 - 9.09；p < 0.001）的独立相关因素。在老年人中，与3个月时良好结局相关的特征包括年龄（OR 0.89，95% CI：0.81 - 0.97；p = 0.01）、初始NIHSS（OR 0.89，95% CI：0.83 - 0.94；p < 0.0001），以及不存在严重白质疏松、抗凝治疗和再灌注治疗后症状性脑出血（分别为OR 0.42，95% CI：0.19 - 0.93；p = 0.03；OR = 0.07，95% CI：0.01 - 0.70；p = 0.02；以及OR = 0.07，95% CI：0.01 - 0.61；p = 0.02）。
尽管再灌注治疗在老年患者中不太成功，但这些患者尽管年龄较大，仍可能从急性再通中获益。随着老年人口的增加，仍需要高质量的前瞻性研究来更好地预测功能结局并明确能够更好地选择合适治疗的标准。
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