Abstract TP7: The Healthy Octogenarian Profile (HOPE): A Simple Indicator of Elderly Stroke Patients that may Benefit from Endovascular Intervention
Background: Octogenarian stroke patients are frequent and they are often excluded from acute revascularization procedures, in particular endovascular interventions, because older age is a poor prognostic factor after stroke and the benefit from interventions is debated. We studied which baseline, peri- and postprocedural factors determine the response to endovascular treatment in octogenarians with acute stroke.
Methods: We first studied a highly homogeneous cohort of 32 octogenarian patients with M1 occlusion treated with endovascular procedures in a comprehensive stroke center. We collected information on history of vascular risk factors as well as a general measure of health, the healthy octogenarian profile (HOPE), defined as absence of any vascular risk factor or known vascular disease. We also measured admission NIHSS score, systolic blood pressure and glucose levels, previous treatment with IV tPA, time to treatment, successful revascularization (TICI2b-3), symptomatic hemorrhage, final infarct volume on MRI and favorable 3-month functional outcome (mRS≤2). The variables associated with outcome were validated in an independent cohort of 34 octogenarians with anterior circulation stroke treated with endovascular procedures in another comprehensive stroke center.
Results: HOPE, history of hypertension and successful recanalization were associated to favorable outcome in univariate analysis. In adjusted models, HOPE remained strongly associated to better outcome (n=8; unadjusted OR=40,p=0.003; adjusted OR=38.9,p=0.02). In the validation cohort, HOPE remained associated to favorable outcome while history of hypertension was not. HOPE remained associated to outcome in adjusted models (n=5; unadjusted OR=9.4,p=0.035; adjusted OR=16,p=0.022). Hemorrhagic complication rate and final infarct volume were not significantly associated to outcome in any of the cohorts.
Conclusions: General health at baseline rather than procedural factors or radiological outcome measures determines the outcome in elderly patients treated with endovascular procedures. Around 20% of octogenarians have the healthy octogenarian profile (HOPE), which identifies patients likely to benefit from endovascular interventions.
- © 2012 by American Heart Association, Inc.