Impact of acute ischemic stroke treatment in patients >80 years of age: the specialized program of translational research in acute stroke (SPOTRIAS) consortium experience

Abstract

Background and purpose: Few studies have addressed outcomes among patients ≥80 years treated with acute stroke therapy. In this study, we outline in-hospital outcomes in (1) patients ≥80 years compared with their younger counterparts; and (2) those over >80 years receiving intra-arterial therapy (IAT) compared with those treated with intravenous recombinant tissue-type plasminogen activator (IV rtPA).

Methods: Stroke centers within the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) prospectively collected data on all patients treated with IV rtPA or IAT from January 1, 2005, to December 31, 2010. IAT was defined as receiving any endovascular therapy; IAT was further divided into bridging therapy when the patient received both IAT and IV rtPA and endovascular therapy alone. In-hospital mortality was compared in (1) all patients aged ≥80 years versus younger counterparts; and (2) IAT, bridging therapy, and endovascular therapy alone versus IV rtPA only among those age ≥80 years using multivariable logistic regression. An age-stratified analysis was also performed.

Results: A total of 3768 patients were included in the study; 3378 were treated with IV rtPA alone and 808 with IAT (383 with endovascular therapy alone and 425 with bridging therapy). Patients ≥80 years (n=1182) had a higher risk of in-hospital mortality compared with younger counterparts regardless of treatment modality (OR, 2.13; 95% CI, 1.60-2.84). When limited to those aged ≥80 years, IAT (OR, 0.95; 95% CI, 0.60-1.49), bridging therapy (OR, 0.82; 95% CI, 0.47-1.45), or endovascular therapy alone (OR, 1.15; 95% CI, 0.64-2.08) versus IV rtPA were not associated with increased in-hospital mortality.

Conclusions: IAT does not appear to increase the risk of in-hospital mortality among those aged >80 years compared with IV thrombolysis alone.

Figure 1. Age effect on In-hospital mortality in different acute stroke therapies

IV rtPA: intravenous recombinant tissue plasminogen activator alone IAT: any intra-arterial therapy ETA: endovascular therapy alone Ref: reference category Unadjusted: univariate analysis Adjusted: Multivariable adjusted for sex, race-ethnicity, and SPOTRIAS center, national institutes of health stroke scale and serum glucose level.

Figure 2. Age effect on discharge disposition other than home in different acute stroke therapies

IV rtPA: intravenous recombinant tissue plasminogen activator alone IAT: any intra-arterial therapy ETA: endovascular therapy alone Ref: reference category Unadjusted: univariate analysis Adjusted: Multivariable analysis adjusted for sex, race-ethnicity, and SPOTRIAS center, national institutes of health stroke scale and serum glucose level.