Michele Romoli, Ludovica Migliaccio, Valentina Saia, Giovanni Pracucci, Luigi Cirillo, Stefano Forlivesi, Daniele Romano, Ilaria Casetta, Enrico Fainardi, Fabrizio Sallustio, Nicola Limbucci, Patrizia Nencini, Valerio Da Ros, Marina Diomedi, Stefano Vallone, Guido Bigliardi, Sergio Lucio Vinci, Paolino La Spina, Mauro Bergui, Paolo Cerrato, Sandra Bracco, Rossana Tassi, Andrea Saletti, Cristiano Azzini, Maria Ruggiero, Lucio Castellan, Tiziana Benzi Markushi, Roberto Menozzi, Alessandro Pezzini, Guido Andrea Lazzarotti, Nicola Giannini, Davide Castellano, Andrea Naldi, Alessio Comai, Elisa Dall'Ora, Mauro Plebani, Manuel Cappellari, Giulia Frauenfelder, Edoardo Puglielli, Alfonsina Casalena, Nicola Burdi, Giovanni Boero, Sergio Nappini, Nicola Davide Loizzo, Nicola Cavasin, Adriana Critelli, Diego Ivaldi, Tiziana Tassinari, Francesco Biraschi, Ettore Nicolini, Sergio Zimatore, Marco Petruzzellis, Pietro Filauri, Berardino Orlandi, Ivan Gallesio, Delfina Ferrandi, Marco Pavia, Paolo Invernizzi, Pietro Amistá, Monia Russo, Adriana Paladini, Annalisa Rizzo, Michele Besana, Alessia Giossi, Marco Filizzolo, Marina Mannino, Salvatore Mangiafico, Danilo Toni, Andrea Zini
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Our aim was to assess EVT effect for ischemic stroke patients aged ⩾80 at a nationwide level.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>Overall, 5872 individuals (1:1 matching, <i>n</i> = 2936 aged ⩾80 vs <i>n</i> = 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%, <i>p</i> < 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.</p><p><strong>Discussion and conclusion: </strong>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.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241299335"},"PeriodicalIF":5.8000,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Stroke thrombectomy in the elderly: A propensity score matched study on a nationwide real-world registry.\",\"authors\":\"Michele Romoli, Ludovica Migliaccio, Valentina Saia, Giovanni Pracucci, Luigi Cirillo, Stefano Forlivesi, Daniele Romano, Ilaria Casetta, Enrico Fainardi, Fabrizio Sallustio, Nicola Limbucci, Patrizia Nencini, Valerio Da Ros, Marina Diomedi, Stefano Vallone, Guido Bigliardi, Sergio Lucio Vinci, Paolino La Spina, Mauro Bergui, Paolo Cerrato, Sandra Bracco, Rossana Tassi, Andrea Saletti, Cristiano Azzini, Maria Ruggiero, Lucio Castellan, Tiziana Benzi Markushi, Roberto Menozzi, Alessandro Pezzini, Guido Andrea Lazzarotti, Nicola Giannini, Davide Castellano, Andrea Naldi, Alessio Comai, Elisa Dall'Ora, Mauro Plebani, Manuel Cappellari, Giulia Frauenfelder, Edoardo Puglielli, Alfonsina Casalena, Nicola Burdi, Giovanni Boero, Sergio Nappini, Nicola Davide Loizzo, Nicola Cavasin, Adriana Critelli, Diego Ivaldi, Tiziana Tassinari, Francesco Biraschi, Ettore Nicolini, Sergio Zimatore, Marco Petruzzellis, Pietro Filauri, Berardino Orlandi, Ivan Gallesio, Delfina Ferrandi, Marco Pavia, Paolo Invernizzi, Pietro Amistá, Monia Russo, Adriana Paladini, Annalisa Rizzo, Michele Besana, Alessia Giossi, Marco Filizzolo, Marina Mannino, Salvatore Mangiafico, Danilo Toni, Andrea Zini\",\"doi\":\"10.1177/23969873241299335\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Data on safety and efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke in older patients are limited and controversial, and people aged 80 or older were under-represented in randomized trials. 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引用次数: 0
摘要
导言：有关血管内血栓切除术（EVT）治疗老年急性缺血性卒中的安全性和有效性的数据有限且存在争议，80 岁或以上的患者在随机试验中的代表性不足。我们的目的是在全国范围内评估对 80 岁以上缺血性中风患者进行 EVT 的效果：研究对象包括接受意大利急性中风血管内治疗登记处（IRETAS）EVT治疗的中风患者。患者事先被分为年轻组和年长组（结果：总计 5872 人（1:1 匹配，n = 2936 年龄⩾80 vs n = 2936 p 讨论和结论：年龄⩾80 岁是功能预后较差的一致预测因素，与成功再灌注和 sICH 无关。需要进行成本效益研究，以量身定制并实施可持续护理，研究重点应放在改善老年患者群体功能预后的策略上。
Stroke thrombectomy in the elderly: A propensity score matched study on a nationwide real-world registry.
Introduction: Data on safety and efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke in older patients are limited and controversial, and people aged 80 or older were under-represented in randomized trials. Our aim was to assess EVT effect for ischemic stroke patients aged ⩾80 at a nationwide level.
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.
期刊介绍：
Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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