Impact of Acute Ischemic Stroke Treatment in Patients > 80 Years of Age: The Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) Consortium Experience

Joshua Z WILLEY; Santiago ORTEGA-GUTIERREZ; Randolph S MARSHALL; Nils PETERSEN; Pooja KHATRI; Andria L FORD; Natalia S ROST; Latisha K ALI; Nichole R GONZALES; Jose G MERINO; Brett C MEYER

doi:10.1161/STROKEAHA.112.660993

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Impact of Acute Ischemic Stroke Treatment in Patients > 80 Years of Age: The Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) Consortium Experience

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Impact of Acute Ischemic Stroke Treatment in Patients > 80 Years of Age: The Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) Consortium Experience

Joshua Z WILLEY, Santiago ORTEGA-GUTIERREZ, Randolph S MARSHALL, Nils PETERSEN, Pooja KHATRI, Andria L FORD, Natalia S ROST, Latisha K ALI, Nichole R GONZALES, Jose G MERINO, …

Stroke (1970), Vol.43(9), pp.2369-2375

2012

DOI: 10.1161/STROKEAHA.112.660993

PMID: 22798327

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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.

Neurology

Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy

Biological and medical sciences

Vascular diseases and vascular malformations of the nervous system

Medical sciences

Nervous system (semeiology, syndromes)

Details

Title: Subtitle: Impact of Acute Ischemic Stroke Treatment in Patients > 80 Years of Age: The Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) Consortium Experience
Creators: Joshua Z WILLEY - Department of Neurology, Columbia University, New York, NY, United States
Santiago ORTEGA-GUTIERREZ - Department of Neurology, Columbia University, New York, NY, United States
Randolph S MARSHALL - Department of Neurology, Columbia University, New York, NY, United States
Nils PETERSEN - Department of Neurology, Columbia University, New York, NY, United States
Pooja KHATRI - Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
Andria L FORD - Department of Neurology, Washington University, St Louis, MO, United States
Natalia S ROST - Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
Latisha K ALI - Department of Neurology, UCLA, Los Angeles, CA, United States
Nichole R GONZALES - University of Texas Houston, Houston, TX, United States
Jose G MERINO - Division of Intramural Research, National Institutes of Health, Bethesda, MD, United States
Brett C MEYER - Department of Neurology, University of California, San Diego, San Diego, CA, United States
Resource Type: Journal article
Publication Details: Stroke (1970), Vol.43(9), pp.2369-2375
DOI: 10.1161/STROKEAHA.112.660993
PMID: 22798327
NLM abbreviation: Stroke
ISSN: 0039-2499
eISSN: 1524-4628
Publisher: Lippincott Williams & Wilkins; Hagerstown, MD
Language: English
Date published: 2012
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984020750802771

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