Functional outcomes of ischemic stroke patients aged over 80 years treated with acute revascularization therapy according to pre-morbid disability: a PARADISE study

Abstract

IntroductionAging population leads to changes in the profile of patients with acute ischemic stroke (IS), and older adults were largely excluded from randomized clinical trials of acute revascularization therapy. This study aimed to assess functional outcomes of treated IS patients > 80 years old according to prior disability and identify associated factors.MethodsConsecutively older patients with acute IS treated with either IV thrombolysis and/or mechanical thrombectomy were enrolled between 2016 and 2019. Pre-morbid disability was assessed using the modified Rankin Scale (mRS) score, and patients were classified as being independent (mRS score, 0–2) or having pre-existing disability (mRS score, 3–5). A multivariable logistic regression analysis was performed to assess factors associated with a poor functional outcome (mRS score > 3) at 3 and 12 months in each group of patients.ResultsAmong 300 included patients (mean age: 86.3 ± 4.6 years, 63% women, median NIHSS score: 14, IQR: 8–19), 100 had a pre-existing disability. In patients with a pre-morbid mRS score of 0–2, 51% had mRS >3 including 33% of deaths at 3 months. At 12 months, 50% had a poor outcome including 39% of deaths. In patients with a pre-morbid mRS score of 3–5, 71% had a poor outcome at 3 months including 43% of deaths, and at 12 months, 76% had mRS >3 including 52% of deaths. In multivariable models, the NIHSS score at 24 h was independently associated with poor outcomes at 3 and 12 months in both patients with (OR = 1.32; 95% CI: 1.16–1.51, p < 0.001 for 12 months outcome) or without (OR = 1.31; 95% CI: 1.19–1.44, p < 0.001 for 12 months outcome) pre-morbid disability.ConclusionAlthough a large proportion of older patients with a pre-existing disability had a poor functional outcome, they did not differ from their non-impaired counterparts regarding prognostic factors. This means that there were no factors in our study that would help clinicians identify patients at risk of poor functional outcomes after revascularization therapy among those with prior disability. Further studies are needed to better understand the post-stroke trajectory of older IS patients with a pre-morbid disability.

Impact of possible sarcopenia on functional prognosis in patients with acute stroke with premorbid disability

“…Furthermore, most studies that have examined the functional prognosis of patients with acute stroke at hospital discharge have excluded those with premorbid disability, and the present results again support previous studies 13,29–31 . In patients with stroke with premorbid disability, premorbid mRS 24 and NIHSS at admission 32 affect the functional prognosis, and other studies have also reported premorbid mRS as a powerful prognostic factor 33,34 . Furthermore, poor premorbid functional status has been reported to be associated with odds of death within 1 year in intensive care unit patients over 85 years old, not only for stroke 35 .…”