Document Detail


Impact of acute ischemic stroke treatment in patients >80 years of age: the specialized program of translational research in acute stroke (SPOTRIAS) consortium experience.
MedLine Citation:
PMID:  22798327     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Joshua Z Willey; Santiago Ortega-Gutierrez; Nils Petersen; Pooja Khatri; Andria L Ford; Natalia S Rost; Latisha K Ali; Nichole R Gonzales; Jose G Merino; Brett C Meyer; Randolph S Marshall
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, N.I.H., Intramural     Date:  2012-07-12
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  43     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-28     Completed Date:  2012-11-05     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2369-75     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over / statistics & numerical data*
Brain Ischemia / mortality,  therapy*
Data Interpretation, Statistical
Endovascular Procedures
Fibrinolytic Agents / administration & dosage,  therapeutic use
Hospital Mortality
Humans
Injections, Intra-Arterial
Injections, Intravenous
Middle Aged
Prospective Studies
Retrospective Studies
Risk
Stroke / mortality,  therapy*
Thrombolytic Therapy / adverse effects,  mortality
Tissue Plasminogen Activator / administration & dosage,  therapeutic use
Translational Medical Research
Grant Support
ID/Acronym/Agency:
1K23 NS 073104-01A1/NS/NINDS NIH HHS; K23 NS064052/NS/NINDS NIH HHS; K23 NS073104/NS/NINDS NIH HHS; KL2 RR024149/RR/NCRR NIH HHS; L30 AG031009/AG/NIA NIH HHS; P50 NS049060/NS/NINDS NIH HHS; P50 NS049060/NS/NINDS NIH HHS; UL1 RR024148/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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