Long-Term Outcomes of Acute Ischemic Stroke in Patients Aged 80 Years and Older

다국어 초록 (Multilingual Abstract)

Purpose: Short life expectancy influences decision-making when treating very old patients with acute ischemic stroke (AIS). We investigated mortality and survival duration in very old AIS patients (≥80 years) who received hospital care. Patients and Methods: Mortality data were obtained from medical records, structured telephone inquiries, death certificates from the Korean National Statistical Office, and social security data 5±1.9 years after stroke onset. Age, gender, vascular risk factors, and functional outcomes from modified Rankin scales (MRS) at discharge were analyzed as predictors of mortality. Results: Among 134 patients, 92 (68.7%) died. On Kaplan- Meier analysis, duration of survival of patients aged 80-84 years was longer than those aged 85-89 or 90-94 (24±6.4, 8±7.3, 7±2.0 months, respectively, p=0.002). Duration of survival of patients discharged in a state of MRS 0-1 was longer than the remaining groups at 47±4.8 months (p< 0.001). In Cox proportional hazard analysis, age and MRS at discharge were independent predictors of mortality. Conclusion: Long-term outcomes of very old patients with AIS are not uniformly grave, therefore predictors of mortality and estimated duration of survival should be considered during decision-making for treatment.

참고문헌 (Reference)

1 Lee BC, "The Hallym Stroke Registry: a web-based stroke data bank with an analysis of 1,654 consecutive patients with acute stroke" 54 : 81-87, 2005

2 Chen CI, "TPA for very old stroke patients" 54 : 140-144, 2005

3 Sharma JC, "Strokes in the elderly- higher acute and 3-month mortality-an explanation" 9 : 2-9, 1999

4 Dennis MS, "Stroke unit versus and neurology ward-a short commentary" 250 : 1370-1371, 2003

5 de Jong G, "Stroke subtype and mortality: a follow-up study in 998 patients with a first cerebral infarct" 56 : 262-268, 2003

6 Di Carlo A, "Stroke in the very old: clinical presentation and determinants of 3-month functional outcome: A European perspective. European BIOMED Study of Stroke Care Group" 30 : 2313-2319, 1999

7 Minn YK, "Significance of silent infarcts in acute ischemic stroke patients aged 80 years and older" 20 : 92-95, 2005

8 Kammersgaard LP, "Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study" 33 : 149-154, 2004

9 Ovbiagele B, "Secondary- prevention drug prescription in the very elderly after ischemic stroke or TIA" 66 : 313-318, 2006

10 Altieri M, "SPASE-1: a multicenter observational study on pharmacological treatment of acute stroke in the elderly. The Italian Study of Pharmacological Treatment of Acute Stroke in the Elderly group" 23 : 23-28, 2002

11 Hacke W, "Randomised double-blinded placebo- controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators" 352 : 1245-1251, 1998

12 Engelter ST, "Intravenous thrombolysis in stroke patients of > or = 80 versus <80 years of age-a systematic review across cohort studies" 35 : 572-580, 2006

13 van Swieten JC, "Interobserver agreement for the assessment of handicap in stroke patients" 19 : 604-607, 1998

14 Hénon H, "Influence of prestroke dementia on early and delayed mortality in stroke patients" 250 : 10-16, 2003

15 Adams HP Jr, "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment" 24 : 35-41, 1993

16 Miller MT, "Carotid endarterectomy in octogenarians: does increased age indicate "high risk?"" 41 : 231-237, 2005

17 North American Symptomatic Carotid Endarterectomy Trial Collaborators, "Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis" 325 : 445-453, 1991

18 Arboix A, "Acute stroke in very old people: clinical features and predictors of in-hospital mortality" 48 : 36-41, 2000

19 Olindo S, "Acute stroke in the very elderly: epidemiological features, stroke subtypes, management, and outcome in Martinique, French West Indies" 34 : 1593-1597, 2003