Journal article
Effect of age and baseline ASPECTS on outcomes in large-vessel occlusion stroke: results from the HERMES collaboration.
- Ospel JM Neuroradiology, University Hospital Basel, Basel, Switzerland.
- Kappelhof M Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
- Kashani N Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
- Menon BK Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
- Campbell BCV Medicine, University of Melbourne, Parkville, Victoria, Australia.
- San Roman L Interventional Neuroradiology, Imaging Diagnostics Center, Hospital Clinic of Barcelona, Barcelona, Spain.
- Demchuk AM Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
- Dippel DWJ Neurology, Erasmus University Medical Center, Rotterdam, Netherlands.
- Saver JL Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
- Jovin TG Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA.
- Mitchell P Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
- Bracard S Radiology, Université de Lorraine, Nancy, France.
- Muir K Institute of Neuroscience and Psychiatry, University of Glasgow, Glasgow, UK.
- White P Institute for Ageing & Health, Newcastle University, Newcastle upon Tyne, UK.
- Guillemin F Clinical Epidemiology, Université de Lorraine and University Hospital of Nancy, Nancy, France.
- Majoie CBLM Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
- Hill MD Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
- Brown S Altair Biostatistics, St. Louis Park, Minnesota, United States.
- Goyal M Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada mgoyal2412@gmail.com.
- 2020-09-15
Published in:
- Journal of neurointerventional surgery. - 2020
English
BACKGROUND
Patient age and baseline Alberta Stroke Program Early CT score (ASPECTS) are both independent predictors of outcome in acute ischemic stroke patients treated with endovascular therapy (EVT). We assessed the combined effect of age and ASEPCTS on clinical outcome in acute ischemic stroke patients with LVO with and without EVT, and EVT treatment effect in different age/ASPECTS subgroups.
METHODS
The HERMES collaboration pooled data of seven randomized controlled trials that tested the efficacy of EVT. Adjusted logistic regression was performed to test for multiplicative interaction of age and ASPECTS with the primary outcome (ordinal mRS) and secondary outcomes (mRS 0-2/0-1/0-3) in the EVT and control arms. Patients were then stratified by age (<75 vs ≥75 years) and ASPECTS (0-5/6-7/8-10), and adjusted effect-size estimates for the association of EVT were derived for the six age/ASPECTS subgroups.
RESULTS
1735 patients were included in the analysis. There was no multiplicative interaction between age and ASPECTS on clinical outcomes. In the exploratory subgroup analysis, we found a nominally negative point estimate for the association of EVT with clinical outcome in the ASPECTS 0-5/age ≥75, subgroup (acOR 0.36, 95% CI 0.07 to 1.89). The point estimate for moderate outcome (mRS0-3) nominally favored EVT (aOR 1.24, 95% CI 0.16 to 9.84). In all other subgroups, effect size-estimates consistently favored EVT.
CONCLUSION
There was no multiplicative interaction of age and ASPECTS on clinical outcomes in EVT or control arm patients. Outcomes in patients ≥75 years with ASPECTS 0-5 were poor, irrespective of treatment. Further investigation to define the role of EVT and range of acceptable outcomes in this subgroup is warranted.
Patient age and baseline Alberta Stroke Program Early CT score (ASPECTS) are both independent predictors of outcome in acute ischemic stroke patients treated with endovascular therapy (EVT). We assessed the combined effect of age and ASEPCTS on clinical outcome in acute ischemic stroke patients with LVO with and without EVT, and EVT treatment effect in different age/ASPECTS subgroups.
METHODS
The HERMES collaboration pooled data of seven randomized controlled trials that tested the efficacy of EVT. Adjusted logistic regression was performed to test for multiplicative interaction of age and ASPECTS with the primary outcome (ordinal mRS) and secondary outcomes (mRS 0-2/0-1/0-3) in the EVT and control arms. Patients were then stratified by age (<75 vs ≥75 years) and ASPECTS (0-5/6-7/8-10), and adjusted effect-size estimates for the association of EVT were derived for the six age/ASPECTS subgroups.
RESULTS
1735 patients were included in the analysis. There was no multiplicative interaction between age and ASPECTS on clinical outcomes. In the exploratory subgroup analysis, we found a nominally negative point estimate for the association of EVT with clinical outcome in the ASPECTS 0-5/age ≥75, subgroup (acOR 0.36, 95% CI 0.07 to 1.89). The point estimate for moderate outcome (mRS0-3) nominally favored EVT (aOR 1.24, 95% CI 0.16 to 9.84). In all other subgroups, effect size-estimates consistently favored EVT.
CONCLUSION
There was no multiplicative interaction of age and ASPECTS on clinical outcomes in EVT or control arm patients. Outcomes in patients ≥75 years with ASPECTS 0-5 were poor, irrespective of treatment. Further investigation to define the role of EVT and range of acceptable outcomes in this subgroup is warranted.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1136/neurintsurg-2020-016621
- PMID 32929047
- Persistent URL
- https://sonar.ch/global/documents/92746
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