80岁以上急性缺血性脑卒中患者静脉注射重组组织浆细胞酶原激活剂的院内疗效：中国卒中中心联盟的研究结果。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-10-28 DOI:10.1016/j.jstrokecerebrovasdis.2024.108102

Yingyu Jiang , Chunjuan Wang , Hongqiu Gu , Qi Zhou , Yong Jiang , Zixiao Li , Yongjun Wang

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(NCT05395351).</div></div><div><h3>Methods</h3><div>This study analyzed adult Chinese patients with AIS who arrived at the hospital within 4.5 hours of symptom onset between August 2015 and July 2019 and were registered in the nationwide, hospital-based Chinese Stroke Center Alliance platform. Patients were categorized by treatment (IV rt-PA versus no IV rt-PA) and age (>80 years versus 18–80 years). In-hospital outcomes were evaluated in IV rt-PA-treated patients. 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引用次数: 0

摘要

背景：急性缺血性卒中（AIS）患者在症状出现后 4.5 小时内静脉注射重组纤溶酶原激活剂（rt-PA）已被证实对患者有益，但在中国老年患者中使用静脉注射 rt-PA 的证据有限。本研究以 18-80 岁患者为参照组，评估了年龄大于 80 岁、在症状出现 4.5 小时内接受静脉注射 rt-PA 的中国患者的特征和院内临床结局。(NCT05395351).Methods:本研究分析了2015年8月至2019年7月期间症状发作4.5小时内到达医院并在全国范围内以医院为基础的中国卒中中心联盟平台注册的中国成年AIS患者。患者按治疗方法（静脉注射rt-PA与不静脉注射rt-PA）和年龄（大于80岁与18-80岁）分类。对接受 IV rt-PA 治疗的患者的院内预后进行了评估。主要结果是住院期间的全因死亡率；次要结果包括住院期间颅内出血（ICH）患者的比例、IV rt-PA前和IV rt-PA后24小时美国国立卫生研究院卒中量表（NIHSS）的变化、出院时的改良Rankin量表（mRS）、住院期间卒中复发患者的比例以及住院时间：在纳入研究的 113035 名 AIS 患者中，有 31418 名患者在症状出现后 4.5 小时内接受了静脉注射 rt-PA（年龄大于 80 岁：3332 人；18-80 岁：28086 人）。在接受静脉注射 rt-PA 治疗的患者中，年龄大于 80 岁和 18-80 岁患者的全因死亡率分别为 2.6%（95% CI 2.1-3.2%）和 0.8%（95% CI 0.7-0.9%）。分别有6.7%（95% CI 5.8-7.5%）和3.1%（95% CI 2.9-3.3%）的患者发生颅内出血；NIHSS评分的平均±SD变化分别为2.8±5.0和2.5±4.3。3；42.8%（95% CI 40.8%-44.8%）和 63.6%（95% CI 62.9%-64.3%）患者出院时 mRS 为 0-1；11.1%（95% CI 10.0-12.1%）和 7.3%（95% CI 7.0-7.6%）患者中风复发。两个年龄组的中位住院时间均为 11 天：结论：年龄大于80岁的中国AIS患者在症状出现后4.5小时内接受静脉注射rt-PA治疗，其住院期间的全因死亡率高于18-80岁的患者。

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In-hospital outcomes of intravenous recombinant tissue plasminogen activator treatment for acute ischemic stroke in patients aged >80 years: Findings from the Chinese Stroke Center Alliance

Background

Intravenous (IV) recombinant plasminogen activator (rt-PA) within 4.5 hours of symptom onset has established benefit for patients with acute ischemic stroke (AIS); however, evidence on the use of IV rt-PA in elderly Chinese patients is limited. This study evaluated the patient characteristics and in-hospital clinical outcomes of Chinese patients aged >80 years who received IV rt-PA within 4.5 h of symptom onset, using patients aged 18–80 years as a reference group. (NCT05395351).

Methods

This study analyzed adult Chinese patients with AIS who arrived at the hospital within 4.5 hours of symptom onset between August 2015 and July 2019 and were registered in the nationwide, hospital-based Chinese Stroke Center Alliance platform. Patients were categorized by treatment (IV rt-PA versus no IV rt-PA) and age (>80 years versus 18–80 years). In-hospital outcomes were evaluated in IV rt-PA-treated patients. Primary outcome was all-cause mortality during hospitalization; secondary outcomes included proportion of patients with intracranial hemorrhage (ICH) during hospitalization, change in National Institutes of Health Stroke Scale (NIHSS) before and 24 h after IV rt-PA, modified Rankin Scale (mRS) at discharge, proportion of patients with stroke recurrence during hospitalization, and duration of hospital stay.

Results

Of 113,035 patients with AIS included in the study, 31,418 patients received IV rt-PA within 4.5 hours after symptom onset (aged >80 years: n=3,332; 18–80 years: n=28,086). Among IV rt-PA-treated patients, all-cause mortality was 2.6 % (95 % CI 2.1–3.2 %) and 0.8 % (95 % CI 0.7–0.9 %) in patients aged >80 years and 18–80 years, respectively. Intracranial hemorrhage occurred in 6.7 % (95 % CI 5.8–7.5 %) and 3.1 % (95 % CI 2.9–3.3 %) of patients; mean±SD change in NIHSS score was 2.8±5.0 and 2.5±4.3; mRS 0–1 at discharge in 42.8 % (95 % CI 40.8 %–44.8 %) and 63.6 % (95 % CI 62.9 %–64.3 %); stroke recurrence in 11.1 % (95 % CI 10.0–12.1 %) and 7.3 % (95 % CI 7.0–7.6 %). Median duration of hospital stay was 11 days in both age groups.

Conclusions

Chinese patients aged >80 years with AIS who received IV rt-PA within 4.5 hours after symptom onset had higher all-cause mortality during hospitalization than those aged 18–80 years.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.