Stroke thrombectomy in the elderly: A propensity score matched study on a nationwide real-world registry.
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Romoli Michele, Migliaccio Ludovica, Saia Valentina, Pracucci Giovanni, Cirillo Luigi, Forlivesi Stefano, Romano Daniele, Casetta Ilaria, Fainardi Enrico, Sallustio Fabrizio, Limbucci Nicola, Nencini Patrizia, Da Ros Valerio, Diomedi Marina, Vallone Stefano, Bigliardi Guido, Vinci Sergio Lucio, La Spina Paolino, Bergui Mauro, Cerrato Paolo, Bracco Sandra, Tassi Rossana, Saletti Andrea, Azzini Cristiano, Ruggiero Maria, Castellan Lucio, Benzi Markushi Tiziana, Menozzi Roberto, Pezzini Alessandro, Lazzarotti Guido Andrea, Giannini Nicola, Castellano Davide, Naldi Andrea, Comai Alessio, Dall'Ora Elisa, Plebani Mauro, Cappellari Manuel, Frauenfelder Giulia, Puglielli Edoardo, Casalena Alfonsina, Burdi Nicola, Boero Giovanni, Nappini Sergio, Loizzo Nicola Davide, Cavasin Nicola, Critelli Adriana, Ivaldi Diego, Tassinari Tiziana, Biraschi Francesco, Nicolini Ettore, Zimatore Sergio, Petruzzellis Marco, Filauri Pietro, Orlandi Berardino, Gallesio Ivan, Ferrandi Delfina, Pavia Marco, Invernizzi Paolo, Amistá Pietro, Russo Monia, Paladini Adriana, Rizzo Annalisa, Besana Michele, Giossi Alessia, Filizzolo Marco, Mannino Marina, Mangiafico Salvatore, Toni Danilo, Zini Andrea
Аннотация
PATIENTS AND METHODS: The cohort included stroke patients undergoing EVT from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). Patients were a priori divided into younger and older groups (<80 vs ⩾80). Primary outcome was good functional outcome (modified Rankin scale, mRS, 0-2 at 90 days). Secondary outcomes were symptomatic intracranial hemorrhage (sICH), successful reperfusion, EVT abortion. Propensity score matching (PSM) was performed between age groups for baseline features, functional status, stroke severity and neuroradiological features. Logistic regression was implemented to test the weight of age group on the predefined outcomes.
RESULTS: Overall, 5872 individuals (1:1 matching, n = 2936 aged ⩾80 vs n = 2936 < 80) were matched from 13,922 records. In ⩾80 group 34.1% had good functional outcome, vs 51.2% in <80 group (absolute difference = -17.1%, p < 0.001), with a 4.4% excess in EVT abortion. Age ⩾80 was a negative independent predictor of good functional outcome (aOR = 0.4, 95% CI = 0.3-0.5), but had no impact on sICH.
DISCUSSION AND CONCLUSION: Age ⩾80 years represents a consistent predictor of worse functional outcome, independently from successful reperfusion and sICH. Cost-effectiveness studies are needed for tailored and implement sustainable care, and research should focus on strategies to improve functional outcome in older age patient groups.