Annals of palliative medicine · 2022
Clinical characteristics and prognosis in oldest old patients with ischaemic stroke or transient ischaemic attack in China.
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Wang Yu, Jing Jing, Pan Yuesong, Wang Mengxing, Meng Xia, Wang Yongjun
Аннотация
BACKGROUND: Limited data are available about the prognosis of ischaemic stroke or transient ischaemic attack (TIA) in oldest-old patients, especially in China. We aimed to describe the clinical characteristics and prognosis of oldest-old patients with ischaemic stroke or TIA in China.
METHODS: Patients with acute ischaemic stroke (AIS) or TIA were recruited between August 2015 and March 2018 in the Third China National Stroke Registry (CNSR-III). Clinical characteristics including demographic data, medical history, medication use and stroke aetiology, were obtained. The outcomes were one-year stroke recurrence, combined vascular events (stroke, myocardial infarction, and cardiovascular death), mortality, and poor functional outcome [modified Rankin scale (mRS) 3-6]. Oldest-old was defined as ≥80 years old. Clinical characteristics and prognosis were compared by different age groups (<65, 65-79, and ≥80 years). The association between age and prognosis was analysed using the multivariable Cox proportional hazards and logistic regression models.
RESULTS: A total of 15,166 patients with AIS or TIA were included in this study with 929 (6.13%) oldest-old patients. Oldest-old patients had a higher likelihood of cardioembolic stroke or comorbid cardiac disease than other age groups. When compared with patients aged <65 years, oldest-old patients had higher risk of one-year stroke recurrence [adjusted hazard ratio (HR) 1.36; 95% confidence interval (CI): 1.06-1.73, P=0.014], combined vascular events [adjusted HR, 1.42; 95% CI, 1.13-1.79, P=0.003], mortality [adjusted odds ratio (OR), 4.25; 95% CI: 2.99-6.04, P<0.001] and poor functional outcome (adjusted OR, 4.25; 95% CI: 3.40-5.33, P<0.001) with P for trends <0.001 among age groups.
CONCLUSIONS: Oldest-old patients differed from younger patients regarding clinical characteristics, stroke aetiology, and secondary preventive medication persistence with a poor clinical prognosis in China. Current information on profile of the oldest-old stroke patients is crucial to develop specific secondary prevention and treatment strategies.
METHODS: Patients with acute ischaemic stroke (AIS) or TIA were recruited between August 2015 and March 2018 in the Third China National Stroke Registry (CNSR-III). Clinical characteristics including demographic data, medical history, medication use and stroke aetiology, were obtained. The outcomes were one-year stroke recurrence, combined vascular events (stroke, myocardial infarction, and cardiovascular death), mortality, and poor functional outcome [modified Rankin scale (mRS) 3-6]. Oldest-old was defined as ≥80 years old. Clinical characteristics and prognosis were compared by different age groups (<65, 65-79, and ≥80 years). The association between age and prognosis was analysed using the multivariable Cox proportional hazards and logistic regression models.
RESULTS: A total of 15,166 patients with AIS or TIA were included in this study with 929 (6.13%) oldest-old patients. Oldest-old patients had a higher likelihood of cardioembolic stroke or comorbid cardiac disease than other age groups. When compared with patients aged <65 years, oldest-old patients had higher risk of one-year stroke recurrence [adjusted hazard ratio (HR) 1.36; 95% confidence interval (CI): 1.06-1.73, P=0.014], combined vascular events [adjusted HR, 1.42; 95% CI, 1.13-1.79, P=0.003], mortality [adjusted odds ratio (OR), 4.25; 95% CI: 2.99-6.04, P<0.001] and poor functional outcome (adjusted OR, 4.25; 95% CI: 3.40-5.33, P<0.001) with P for trends <0.001 among age groups.
CONCLUSIONS: Oldest-old patients differed from younger patients regarding clinical characteristics, stroke aetiology, and secondary preventive medication persistence with a poor clinical prognosis in China. Current information on profile of the oldest-old stroke patients is crucial to develop specific secondary prevention and treatment strategies.