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.
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Twitter @johanna_ospel, @nimakashani, @mihill68
Collaborators HERMES collaborators
Contributors MG: conceptualization, drafting, and critical revision of the manuscript. JMO, MK: data acquisition, drafting, and critical revision of the manuscript. SB: statistical analysis and critical revision of the manuscript. Remaining authors: data curation, critical revision of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests JMO is supported by the University of Basel Research Foundation, Julia Bangerter Rhyner Foundation, and Freiwillige Akademische Gesellschaft Basel. Mayank Goyal is a consultant for Medtronic, Stryker, Microvention, GE Healthcare, and Mentice.
Patient consent for publication Not required.
Ethics approval Approval from the University of Calgary’s ethics committee was obtained prior to the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Raw data will be made available by the corresponding author upon reasonable request after approval by the HERMES Executive Committee.
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