The Impact of Age on Mortality and Disability in Patients With Ischemic Stroke Who Underwent Cerebral Reperfusion Therapy: A Brazilian Cohort Study

Abstract

Introduction: The main driver for increased stroke prevalence is the aging of the population; however, the best evidenced-based strategies for stroke treatment and prevention are not always followed for older patients. Therefore, the aim was studying the association of age with clinical outcomes (mortality and functional disability) in stroke patients who underwent cerebral reperfusion therapy at hospital discharge and 90 days after ictus.Methods: This was a retrospective (stroke databank analysis) cohort study of participants who had been diagnosed with ischemic stroke and undergone intravenous cerebral reperfusion therapy or mechanical thrombectomy. The variable of interest was patient age, which was categorized into four groups: (1) up to 59 years; (2) 60 to 69 years; (3) 70 to 79 years old; and (4) above 79 years. The primary outcome was mortality at hospital discharge and 90 days after stroke, and the secondary outcome was functional capacity at hospital discharge and 90 days after stroke.Results: A total of 281 patients was included in the study (235 treated by thrombolysis alone, and 46 treated with mechanical thrombectomy). The mean age of the total sample was 67 ± 13.1 years. The oldest patients had the most unfavorable outcomes, except for mortality rate, at hospital discharge (mRS > 2; OR: 1.028; 95% CI 1.005 to 1.051; p = 0.017; mRS > 3; OR: 1.043, 95% CI 1.018 to 1.069; p = 0.001) and 90 days after stroke (mRS > 2; OR: 1.028; 95% CI 1.005 to 1.051; p = 0.017; mRS > 3; OR: 1.043, 95% CI 1.018 to 1.069; p = 0.001).Conclusion: Cerebral reperfusion was a viable treatment for ischemic stroke in both elderly and very elderly patients, as it did not increase mortality. However, it was observed that older individuals had worse functional outcomes at hospital discharge and 90 days after stroke.

Prognostic significance of age in patients with acute ischaemic stroke treated with intravenous thrombolysis

“…Patient data was collected prospectively in the University Hospital in Krakow as part of a single-centre registry known as the Krakow Stroke Data Bank. Our study focused on age further categorised into four subgroups in a similar way as in the previous study of the Brazilian stroke cohort [7], i.e. : (I) below 60, (II) 60 to 69, (III) 70 to 79, and (IV) 80 or above.…”

“…Patients aged 80 or more who had mRS 3-6 90 days after stroke onset (n = 53) compared to those with favourable outcome (n = 49) had higher NIHSS score on admission (16 [14-20] vs. 7 [5][6][7][8][9][10][11][12], p < 0.001) and after IVT (15 [8][9][10][11][12][13][14][15][16][17][18] vs. 2 [1-6], p < 0.001), more often had haemorrhagic brain complications after IVT (35.85% vs. 8.16%, p < 0.001) and premorbid disability (pre-stroke mRS score ≥ 1: 28.30% vs. 8.16%, p = 0.010), less often had fasting glucose level below 5.5 mmol/L (9.43% vs. 26.53%, p = 0.023), had higher CRP levels (27.2 [9.1-84.1] vs. 4.3 [2.1-10.3] mg/L, p < 0.001), and had higher maximal diastolic blood pressure within 24 hours after IVT (80 [72-90] vs. 80 [70-85] mmHg, p = 0.026) (Supplemental Tab. 1).…”

“…1). Patients below 60 who had mRS 3-6 90 days after stroke onset (n = 10) compared to those with a favourable outcome (n = 59) more often suffered from hypertension (90.00% vs. 54.24%, p = 0.033), more often underwent MT (90.00% vs. 38.98%, p = 0.028), had higher NIHSS score on admission (19 [18-20] vs. 9 [5][6][7][8][9][10][11][12][13][14][15][16], p = 0.005) and after IVT (19 [15][16][17][18][19] vs. 4 [2][3][4][5][6][7][8], p < 0.001), more often had haemorrhagic brain complications after IVT (70.00% vs. 14.56%, p < 0.001), and had higher CRP levels (9.3 [7.2-14.0] vs. 4.0 [1.5-7.7] mg/L, p = 0.018) (Supplemental Tab. 1).…”

“…4). Patients below 60 who had mRS 3-6 90 days after stroke onset (n = 9) compared to those with a favourable outcome (n = 23) had higher NIHSS score on admission (19 [18-20] vs. 16 [10][11][12][13][14][15][16][17][18], p = 0.015) and after IVT (19 [16][17][18][19] vs. 6 [3][4][5][6][7][8][9][10][11], p < 0.001) and more often had haemorrhagic brain complications after IVT (77.78% vs. 26.09%, p = 0.031) (Supplemental Tab. 4).…”

“…Previous older studies showed that patients with AIS treated with IVT and aged 80 or more had three times higher three-month mortality compared to those below 80, with no significant difference in the rate of secondary symptomatic intracranial haemorrhage [6]. A recent Brazilian study revealed instead that, although patients with AIS treated with IVT or mechanical thrombectomy (MT) after the age of 80 had an increased risk of an unfavourable outcome when compared to younger individuals, the mortality rate was similar in all studied age subgroups [7]. Previous older studies have highlighted that the prevalence of cerebrovascular risk factors such as hypertension, diabetes mellitus, atrial fibrillation, and dyslipidemia is higher in the elderly, possibly leading to increased mortality and unfavourable outcomes in cases of AIS treated with IVT [8].…”