Age differences in utilization and outcomes of tissue-plasminogen activator and mechanical thrombectomy in acute ischemic stroke

It is your responsibility to be in the correct age range; your stroke hospital obviously has no responsibility to fix this problem.

Age differences in utilization and outcomes of tissue-plasminogen activator and mechanical thrombectomy in acute ischemic stroke

 

• Nandakumar Nagaraja
• Urvish K. Patel
• Seemant Chaturvedi

Published:December 07, 2020DOI:https://doi.org/10.1016/j.jns.2020.117262

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Highlights

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  Patients with ischemic stroke aged >80 years receive one-fourth less t-PA and half less MT compared to young adults 18–45 years age.
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  In-hospital mortality is higher by seven-fold in patients >80 years compared to young adults who receive t-PA alone.
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  Discharge to home is reduced by 80% in patients >80 years compared to young adults who receive t-PA alone and MT alone.

Abstract

Background and purpose

U.S. demographics is shifting towards older population. Older stroke patients likely receive less tissue-plasminogen activator (t-PA) and mechanical thrombectomy (MT) compared to younger patients. The objective of this study is to evaluate extent of difference in utilization of t-PA and MT and outcomes of stroke between three age groups −18–45 (young adults), 46–80 (middle/old), and > 80 (oldest old) years.

Methods

It is a retrospective cross-sectional observational study. Primary outcomes were rates of stroke intervention and effect of age on stroke intervention. Secondary outcomes were in-hospital mortality, discharge to home, and prolonged length of stay. Multivariate survey-logistic regression was performed to evaluate outcomes.

Results

Among 487,105 patients in the study 4.8% were young adults, 66.6% middle/old, and 28.6% oldest old. Compared to young adults, middle/old received 19% (OR = 0.81; 95%CI = 0.72–0.91) less t-PA alone; and 33% (OR = 0.67; 95%CI = 0.53–0.83) less MT alone; oldest old received 25% less t-PA alone (OR = 0.75; 95%CI = 0.66–0.86) and 51% (OR = 0.49; 95%CI = 0.38–0.63) less MT alone.

Compared to young adults, in-hospital mortality was three-fold higher among middle/old (OR = 3.5; 95%CI = 1.3–9.6), and seven-fold higher among oldest old (OR = 7.5; 95%CI = 2.8–20.5) for t-PA alone; discharge to home reduced by 40% in middle/old (OR = 0.6; 95%CI = 0.4–0.7) and by 80% in oldest old (OR = 0.2; 95%CI = 0.1–0.2) for t-PA alone and similarly for MT alone.

Conclusions

Oldest old receive one-fourth less t-PA and half less MT compared to young adults. Oldest old patients who received t-PA alone or MT alone had remarkably worse outcomes for in-hospital mortality and discharge to home than young adults did.