Effectiveness of intravenous recombinant plasminogen activator treatment in Chinese patients with acute ischaemic stroke aged over 80 years: a retrospective cohort study.

Background: Risks and benefits of intravenous recombinant tissue plasminogen activator (rt-PA) remain unclear among elderly patients with acute ischaemic stroke (AIS). This study investigated 1-year clinical outcomes of intravenous rt-PA treatment in Chinese patients aged >80 years with AIS.

Methods: This retrospective multicentre study included patients with AIS aged >80 years from the Computer-based Online Database of Acute Stroke Patients for Stroke Management Quality Evaluation stroke registry platform between January 2017 and March 2020 who arrived at the hospital within 4.5 hours of symptom onset. Patients who received intravenous rt-PA were propensity score-matched (1:1) by baseline characteristics with those who did not receive reperfusion therapy. The primary outcome was modified Rankin scale (mRS) score 0-1 at 1 year; secondary outcomes were any intracranial haemorrhage (ICH) and all-cause mortality during hospitalisation, mRS 0-2, mRS score distribution and all-cause mortality at 1 year.

Results: The analysis included 1560 propensity score-matched elderly patients (intravenous rt-PA, n=780; non-reperfusion, n=780). At 1 year, the intravenous rt-PA group had a higher proportion of patients with mRS 0-1 (27.7% vs 23.8%; OR 1.87, 95% CI 1.35 to 2.59, p<0.001), mRS 0-2 (37.3% vs 33.7%; OR 2.02, 95% CI 1.48 to 2.75, p<0.001) and an overall shift towards better outcomes than placebo (mRS mean±SD score: 3.5±2.4 vs 3.7±2.3; OR 0.77, 95% CI 0.64 to 0.93, p=0.007). No significant differences were observed in any ICH and all-cause mortality during hospitalisation and at 1 year.

Conclusions: This study provided real-world evidence for a positive benefit-risk profile of intravenous rt-PA in Chinese patients with AIS aged >80 years.

Trial registration number: NCT05401149.