Abstract 3214: Acute Stroke Treatment In Patients Older Than 80 Across The Spotrias Consortium
Introduction: Prior studies caution against use of intravenous thrombolysis (IVrtPA) for acute ischemic stroke in patients ≥80 years old, but few have described outcomes in this population treated with intra-arterial therapy (IAT). In this study we describe patterns of treatment with IVrtPA and IAT based on age across a network of academic stroke centers, and in-hospital outcomes in patients ≥80 years treated with IAT.
Methods: Stroke centers within the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) prospectively collected data on all patients treated with IVrtPA or IAT including demographics, pre-treatment National Institutes of Health Stroke Scale (NIHSS), discharge destination, and in-hospital mortality. Symptomatic hemorrhage data was not systematically collected. Pre-stroke modified Rankin scale (mRS) was collected at only 6 sites (n = 2074). Proportions of total treated patients based on two age categories (<80 and ≥80), stroke severity (NIHSS), treatment modality (IVrtPA alone vs. IAT combined with IVrtPA), and center were compared using a chi-square statistic. In-hospital mortality in patients ≥80 with an NIHSS≥12 was analyzed using logistic regression, with IAT as the principal explanatory variable.
Results: Over 6 years a total of 2879 were treated with IVrtPA alone, and 425 with combined IVrtPA and IAT between 1/1/05 and 12/31/10. The proportion of patients ≥80 years treated with IVrtPA varied significantly between the centers (19.4%-50.4, p<0.0001). Those ≥80 years were more likely to have severe strokes (NIHSS≥12) than younger patients (64.9% vs. 48.4%, p<0.0001) and were less likely to receive combined therapy (9.5% vs 14.5%, p<0.0001). When limited to those patients with an NIHSS≥12, the patients ≥80 years were less likely to receive IAT (12.8% vs 24.6%, p < 0.0001). The number of patients with age≥80 and an NIHSS≥12 discharged home were 68 (9.1%). When limiting analyses to those age ≥80 and an NIHSS≥12 (n = 751), and adjusting for race, glucose, center, and gender, IAT was not associated with mortality (adjusted OR 1.27, 95% CI 0.70-2.27). Inclusion of pre-stroke mRS did not appreciably change the results. The number of patients discharged home with age≥80 and an NIHSS≥12 were too low to run multi-variable models.
Conclusions: Older patients are less likely to be treated with IAT, though there is significant variability in patterns of IVrtPA and IAT treatment across a consortium of academic stroke centers. IAT appeared safe in this population.
- © 2012 by American Heart Association, Inc.