老年人血管内治疗后结局测量无种族差异。
No Racial Disparity in Outcome Measures After Endovascular Treatment for Stroke in the Elderly.
机构信息
Department of Neurology, Emory University School of Medicine-Atlanta, GA (M.H.M., D.C.H., L.P., A.R.A.-B., N.B., B.L., N.B., M.R.F., R.G.N.).
Marcus Stroke & Neuroscience Center, Grady Memorial Hospital-Atlanta, GA (M.H.M., D.C.H., L.P., A.R.A.-B., N.B., B.L., N.B., M.R.F., R.G.N.).
出版信息
Stroke. 2022 Jan;53(1):128-133. doi: 10.1161/STROKEAHA.120.033537. Epub 2021 Oct 6.
BACKGROUND AND PURPOSE
Despite the lower rates of good outcomes and higher mortality in elderly patients, age does not modify the treatment effect of mechanical thrombectomy for large vessel occlusion strokes. We aimed to study whether racial background influences the outcome after mechanical thrombectomy in the elderly population.
METHODS
We reviewed a prospectively maintained database of patients with acute ischemic stroke treated with mechanical thrombectomy from October 2010 through June 2020 to identify all consecutive patients with age ≥80 years and anterior circulation large vessel occlusion strokes. The patients were categorized according to their race as Black and White. Univariable and multivariable analyses were performed to define the predictors of 90-day modified Rankin Scale and mortality in the overall population and in each race separately.
RESULTS
Among 2241 mechanical thrombectomy, a total of 344 patients (median [interquartile range]; age 85 [82-88] years, baseline National Institutes of Health Stroke Scale score of 19 [15-23], Alberta Stroke Program Early CT Score 9 [7-9], 69.5% females) were eligible for the analysis. White patients (n=251; 73%) had significantly lower median body mass index (25.37 versus 26.89, =0.04) and less frequent hypertension (78.9% versus 90.3%, =0.01) but more atrial fibrillation (64.5% versus 44.1%, =0.001) compared with African Americans (n=93; 27%). Other clinical, imaging, and procedural characteristics were comparable between groups. The rates of symptomatic intracerebral hemorrhage, 90-day modified Rankin Scale score of 0 to 2, and mortality were comparable among both groups. On multivariable analysis, race was neither a predictor of 90-day modified Rankin Scale score of 0 to 2 (White race: odds ratio, 0.899 [95% CI, 0.409-1.974], =0.79) nor 90-day mortality (White race: odds ratio, 1.368; [95% CI, 0.715-2.618], =0.34).
CONCLUSIONS
In elderly patients undergoing mechanical thrombectomy for acute ischemic stroke, there was no racial difference in terms of outcome.
背景与目的
尽管老年患者的良好结局率较低且死亡率较高，但年龄并不能改变机械取栓治疗大血管闭塞性卒中的治疗效果。我们旨在研究种族背景是否会影响老年人群机械取栓后的结局。
方法
我们回顾性分析了 2010 年 10 月至 2020 年 6 月期间接受机械取栓治疗的急性缺血性卒中患者的前瞻性维护数据库，以确定所有年龄≥80 岁且前循环大血管闭塞性卒中的连续患者。根据患者的种族将其分为黑人（Black）和白人（White）。我们进行了单变量和多变量分析，以确定总体人群和每个种族的 90 天改良 Rankin 量表评分和死亡率的预测因素。
结果
在 2241 例机械取栓中，共有 344 例患者（中位数[四分位距]；年龄 85[82-88]岁，基线国立卫生研究院卒中量表评分 19[15-23]，阿尔伯塔卒中计划早期 CT 评分 9[7-9]，女性占 69.5%）符合分析条件。白人患者（n=251；73%）的平均体重指数明显较低（25.37 比 26.89，=0.04），高血压频率较低（78.9%比 90.3%，=0.01），但心房颤动频率较高（64.5%比 44.1%，=0.001）。与非裔美国人（n=93；27%）相比。两组间的其他临床、影像学和程序特征无显著差异。两组间症状性颅内出血、90 天改良 Rankin 量表评分 0-2 分和死亡率的发生率无显著差异。多变量分析显示，种族既不是 90 天改良 Rankin 量表评分 0-2 分的预测因素（白人种族：比值比，0.899[95%置信区间，0.409-1.974]，=0.79），也不是 90 天死亡率的预测因素（白人种族：比值比，1.368；[95%置信区间，0.715-2.618]，=0.34）。
结论
在接受急性缺血性卒中机械取栓治疗的老年患者中，种族间在结局方面没有差异。
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