Medical intensive care unit, Grenoble Alpes University Hospital, Grenoble, France.
Stroke unit, Grenoble Alpes University Hospital, Grenoble, France; Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000 Grenoble, France.
Rev Neurol (Paris). 2023 Dec;179(10):1068-1073. doi: 10.1016/j.neurol.2023.03.023. Epub 2023 Aug 16.
Elderly patients are a growing population in stroke units, characterized by higher frailty, but underrepresented in clinical trials about acute care. We investigated efficacy of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in elderlies in current practice.
We assessed consecutive patients with acute ischemic stroke (AIS) hospitalized in the four stroke units of the French Northern Alps Emergency Network between 2015 and 2020. We compared baseline characteristics, early neurological evolution and outcome of patients aged 80-89 and≥90years old (yo).
Among 8367 patients, 2744 (32.8%) were 80-89 yo and 541 (6.5%) were≥90 yo. IVT and/or MT were performed in 787 patients≥80 yo (632 patients aged 80-89, 155 patients aged>90). Early neurological improvement was more frequent in patients≥80 yo treated by IVT and/or MT compared to untreated patients (45.6% versus 38.4%, P=0.002). After adjustment, reperfusion treatments improved likelihood of good outcome at discharge (OR=2.0 [1.6-2.7]) and reduced in-hospital mortality (OR=0.5 [0.4-0.7]). Age and initial NIHSS score were independent factors of poor functional outcome at discharge and in-hospital mortality. The rate of successful recanalization was comparable between octogenarians and nonagenarians (87% versus 85.2%, P=0.8). Octogenarians had better functional outcome at discharge compared to nonagenarians [modified Rankin scale (mRS) 0-2: 36% versus 25.7%, P=0.02], whatever IVT or MT strategy. In-hospital mortality was lower for octogenarians compared to nonagenarians (19.5% versus 27.1%, P=0.04).
IVT and MT improve early neurological recovery and functional outcome at discharge of both octogenarians and nonagenarians in current practice. Despite a poorer outcome for nonagenarians than octogenarians, these reperfusion treatments should not be withheld on the basis of age only.
老年患者是卒中单元中不断增长的人群，其特点是衰弱程度更高，但在急性治疗的临床试验中代表性不足。我们研究了目前的实践中静脉溶栓（IVT）和机械取栓（MT）对老年人的疗效。
我们评估了 2015 年至 2020 年期间法国北部阿尔卑斯紧急网络的四个卒中单元住院的急性缺血性卒中（AIS）连续患者。我们比较了 80-89 岁和≥90 岁（岁）患者的基线特征、早期神经功能演变和结局。
在 8367 名患者中，2744 名（32.8%）为 80-89 岁，541 名（6.5%）为≥90 岁。在≥80 岁的患者中，有 787 名接受了 IVT 和/或 MT 治疗（632 名 80-89 岁，155 名>90 岁）。与未治疗的患者相比，接受 IVT 和/或 MT 治疗的≥80 岁患者早期神经功能改善更为常见（45.6%比 38.4%，P=0.002）。调整后，再灌注治疗提高了出院时良好结局的可能性（OR=2.0[1.6-2.7]），降低了住院死亡率（OR=0.5[0.4-0.7]）。年龄和初始 NIHSS 评分是出院时和住院期间死亡率差的独立因素。80 岁和 90 岁以上患者的血管再通率相似（87%比 85.2%，P=0.8）。与 90 岁以上患者相比，80 岁患者出院时的功能结局更好[改良 Rankin 量表（mRS）0-2：36%比 25.7%，P=0.02]，无论 IVT 或 MT 策略如何。与 90 岁以上患者相比，80 岁患者的住院死亡率较低（19.5%比 27.1%，P=0.04）。
目前的实践中，IVT 和 MT 可改善 80 岁和 90 岁以上患者的早期神经恢复和出院时的功能结局。尽管 90 岁以上患者的结局比 80 岁患者差，但不应仅基于年龄而不进行这些再灌注治疗。
