Key result
Non-comprehensive stroke centers are linked to ~2-fold higher SICH rates after IV thrombolysis than CSCs.
Why the study?
The safety and effectiveness of intravenous thrombolysis in individuals aged 80 and older across different hospital settings in routine practice were not confirmed.
Observational (n=3,231)
Yes
Answers are grounded in this paper and cite their sources.
OBJECTIVES: The aim of the study was to confirm the safety and effectiveness of using intravenous thrombolysis (IVT) with individuals aged 80 and older in routine practice in different hospital settings. DESIGN: Observasional registry. SETTING: Prospective multicenter population-based registry of acute stroke patients treated with reperfusion therapies in Catalonia, Spain (Sistema Online d'Informació de l'Ictus Agut). PARTICIPANTS: Individuals treated only with IVT (N = 3,231; 1,189 (36.8%) aged ≥80). MEASUREMENTS: Symptomatic intracranial hemorrhage, mortality, and favorable outcome (modified Rankin Scale (mRS) score = 0-2) at 3 months were evaluated according to hospital characteristics. Treating hospitals were classified in three categories: comprehensive stroke centers (CSCs), primary stroke centers (PSCs), and community hospitals operating a telestroke system (TS). First individuals aged 80 and older were compared with those younger than 80, and then participants aged 80 and older were focused on. RESULTS: Participants aged 80 and older had significantly higher baseline National Institute of Health Stroke Scale (NIHSS) scores, longer onset to treatment times, and worse outcomes than younger participants. For participants aged 80 and older, 90-day mortality was 23.2%, with 38.7% having favorable outcomes at 3 months. Symptomatic intracranial hemorrhage (SICH; Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy definition) was observed in 4.7% of subjects. None of the risk factors differed significantly between participants treated in different types of hospitals. Basal stroke severity measured according to NIHSS score was not significantly different either. The three different types of hospitals achieved similar outcomes, although the TS and PSC hospitals had significantly higher proportions of SICH (6.3% and 6.3%, respectively) than the CSC (3.2%). CONCLUSION: Older adults with acute stroke treated with IVT had similar outcomes regardless of hospital characteristics.
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Purroy et al. (2017) conducted an observational in Acute stroke (n=3,231). Treatment at primary stroke centers (PSCs) or telestroke systems (TS) vs. Treatment at comprehensive stroke centers (CSCs) was evaluated on Symptomatic intracranial hemorrhage (SICH). Older adults with acute stroke treated with intravenous thrombolysis had similar overall outcomes regardless of hospital type, although TS and PSC hospitals had higher rates of SICH (6.3%) than CSCs (3.2%).
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