Mechanical thrombectomy in stroke patients of advanced age with score-based prediction of outcome

医学 改良兰金量表 置信区间 优势比 冲程(发动机) 内科学 缺血性中风 机械工程 工程类 缺血
作者
Nicolaj Grønbæk Laugesen,Andreas Hjelm Brandt,Trine Stavngaard,Joan Højgaard,Klaus Hansen,Thomas Truelsen
出处
期刊:Interventional Neuroradiology [SAGE]
卷期号:: 159101992211490-159101992211490 被引量:4
标识
DOI:10.1177/15910199221149073
摘要

Background Stroke patients ≥80 years constituted only 15% in randomised trials on mechanical thrombectomy (MT), but is a considerable higher proportion in clinical practice. Association of clinical variables collected before MT with functional outcome has not been independently described in these patients, while being important in the decision of patient eligibility for MT. Methods We included patients consecutively at a single centre (2017–2021) categorised as octogenarians (age: 80–89 years) or nonagenarians (age: 90–99 years). Functional outcome at 90 days was defined as fair (modified Rankin Scale (mRS) 0–3) or poor (mRS 4–6). Clinical variables collected before MT were analysed for association with shift of mRS in a poor direction. Significant predictors were used to produce a risk score of fair outcome. Significance was set at the p < 0.05 level. Results Nonagenarians (n = 43, 15.5%) compared to octogenarians (n = 235, 84.5%) less likely achieved fair outcome (20.9% vs. 46.0%, p < 0.01) with higher mortality (65.1% vs. 31.9%, p < 0.01). Significant predictors of outcome were: age, adjusted odds ratio (aOR) = 0.91 (95% confidence interval (CI): 0.86–0.97); pre-stroke mRS, aOR = 0.57 (95% CI: 0.44–0.73); National Institute of Health Stroke Scale at admission, aOR = 0.91 (95% CI: 0.87–0.95); Alberta Stroke Program Early Computed Tomography, aOR = 1.23 (95% CI: 1.05–1.45). After bootstrap validation, the area under the curve of the risk score was 0.74 and the optimal cut-off for fair outcome was a score of >7 points. Conclusions One in two octogenarians achieved fair outcome, however, only one in five nonagenarians had fair outcome. The clinical risk score could be considered as guidance when deciding patient eligibility for MT.

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