国家神经系统疾病临床医学研究中心数据管理与共享系统

发表杂志：Stroke and vascular neurology

发表类型: Original Articles

影响因子(IF): 4.4

PMID: 39481878 Pubmed原文链接 全文下载

Stroke is the leading cause of death in China,1-3 and China has the highest estimated lifetime risk of stroke among individuals aged 25 years and above.4 Despite the aggressive stroke prevention strategies implemented by the Chinese government, the prevalence of stroke continues to increase with the increasing population.3,5 Furthermore, the prevalence of stroke increases with age. In 2019, the prevalence of ischemic stroke in patients aged 65-69 was 6.58%, while the prevalence in patients aged 80 years and above was as high as 12.81%.6 Importantly, acute ischemic stroke in elderly patients results in a more severe neurological deficit than stroke among younger individuals, thus producing more disabling and fatal outcomes.7 With the deepening of China's aging society, China's population aged 80 years and above is growing rapidly. The population of this age group was 26 million in 2019, and it is expected to grow to 115 million by 2050.8 Therefore, it is necessary to determine how to reduce the disability rate of elderly stroke patients (> 80 years old). Intravenous thrombolysis (IVT) with alteplase is an effective treatment for acute ischemic stroke by reperfusion and reduces the disability rate associated with ischemic stroke.9,10 However, its application has been limited based on age. In 2013 and 2014, respectively, the American Heart Association11 and the Chinese Academy of Neurology12 no longer considered age older than 80 years as a contraindication for IVT within 3 hours from symptom onset. In 2018, the IVT time window was reported to be 4.5 hours.13,14 As the guidelines are being revised at both domestic and international levels, many elderly patients will be eligible for benefits. As a result, the rate of intravenous thrombolysis in elderly American patients increased significantly from 2016 to 2017 compared to 2008 to 2009.15 To date, there has been no large cohort study of IVT in patients aged > 80 years in China.16,17 In addition, trends in the rate of IVT use among elderly patients remain understudied. A complete understanding of the status and trends of IVT in elderly patients in China will help managers and doctors develop more accurate treatment strategies for elderly patients and improve the rate of IVT in elderly patients. This study aims to explore the in-hospital outcomes in elderly patients treated with IVT with or without alteplase and describe the temporal trend of the IVT rate in patients > 80 and ≤80 years old.

Data for this analysis were obtained from the China Stroke Center Alliance programme, a nationwide, multicentre, prospective registry encompassing 1751 hospitals across 31 provinces, covering the period from 1 January 2018 to 14 December 2022. The primary outcome was defined as a modified Rankin Scale (mRS) Score of 0–2 at discharge. Secondary outcomes included an mRS Score of 0–1 and independent ambulation on discharge. Safety outcomes assessed were in-hospital mortality and symptomatic intracranial haemorrhage (sICH).