Ruel Ségolène, Baptiste Laura, Duloquin Gauthier, Béjot Yannick
Dijon Stroke Registry, Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon, France.
Front Neurol. 2023 Jun 22;14:1186288. doi: 10.3389/fneur.2023.1186288. eCollection 2023.
Aging population leads to changes in the profile of patients with acute ischemic stroke (IS), and older adults were largely excluded from randomized clinical trials of acute revascularization therapy. This study aimed to assess functional outcomes of treated IS patients > 80 years old according to prior disability and identify associated factors.
Consecutively older patients with acute IS treated with either IV thrombolysis and/or mechanical thrombectomy were enrolled between 2016 and 2019. Pre-morbid disability was assessed using the modified Rankin Scale (mRS) score, and patients were classified as being independent (mRS score, 0-2) or having pre-existing disability (mRS score, 3-5). A multivariable logistic regression analysis was performed to assess factors associated with a poor functional outcome (mRS score > 3) at 3 and 12 months in each group of patients.
Among 300 included patients (mean age: 86.3 ± 4.6 years, 63% women, median NIHSS score: 14, IQR: 8-19), 100 had a pre-existing disability. In patients with a pre-morbid mRS score of 0-2, 51% had mRS >3 including 33% of deaths at 3 months. At 12 months, 50% had a poor outcome including 39% of deaths. In patients with a pre-morbid mRS score of 3-5, 71% had a poor outcome at 3 months including 43% of deaths, and at 12 months, 76% had mRS >3 including 52% of deaths. In multivariable models, the NIHSS score at 24 h was independently associated with poor outcomes at 3 and 12 months in both patients with (OR = 1.32; 95% CI: 1.16-1.51, < 0.001 for 12 months outcome) or without (OR = 1.31; 95% CI: 1.19-1.44, < 0.001 for 12 months outcome) pre-morbid disability.
Although a large proportion of older patients with a pre-existing disability had a poor functional outcome, they did not differ from their non-impaired counterparts regarding prognostic factors. This means that there were no factors in our study that would help clinicians identify patients at risk of poor functional outcomes after revascularization therapy among those with prior disability. Further studies are needed to better understand the post-stroke trajectory of older IS patients with a pre-morbid disability.
人口老龄化导致急性缺血性脑卒中（IS）患者的特征发生变化，而老年人在很大程度上被排除在急性血管再通治疗的随机临床试验之外。本研究旨在根据既往残疾情况评估80岁以上接受治疗的IS患者的功能结局，并确定相关因素。
连续纳入2016年至2019年间接受静脉溶栓和/或机械取栓治疗的老年急性IS患者。使用改良Rankin量表（mRS）评分评估病前残疾情况，患者被分为独立（mRS评分，0 - 2）或有既往残疾（mRS评分，3 - 5）。进行多变量逻辑回归分析，以评估每组患者在3个月和12个月时与功能结局不良（mRS评分>3）相关的因素。
在纳入的300例患者中（平均年龄：86.3±4.6岁，63%为女性，美国国立卫生研究院卒中量表[NIHSS]评分中位数：14，四分位数间距：8 - 19），100例有既往残疾。病前mRS评分为0 - 2的患者中，51%的mRS>3，其中3个月时33%死亡。12个月时，50%结局不良，其中39%死亡。病前mRS评分为3 - 5的患者中，3个月时71%结局不良，其中43%死亡；12个月时，76%的mRS>3，其中52%死亡。在多变量模型中，24小时时的NIHSS评分与有（比值比[OR]=1.32；95%置信区间[CI]：1.16 - 1.51，12个月结局P<0.001）或无（OR = 1.31；95% CI：1.19 - 1.44，12个月结局P<0.001）病前残疾的患者在3个月和12个月时的不良结局独立相关。
尽管很大一部分有既往残疾的老年患者功能结局不良，但他们在预后因素方面与无残疾的患者并无差异。这意味着在我们的研究中，没有因素能够帮助临床医生在有既往残疾的患者中识别出血管再通治疗后功能结局不良风险的患者。需要进一步研究以更好地了解有既往残疾的老年IS患者的卒中后病程。
