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Abstract
Background Despite the remarkable effectiveness of endovascular treatment (EVT), recent randomized controlled trials indicate that up to half of patients with large core infarction have a very poor outcome (modified Rankin Scale score 5–6 at 90 days). This study investigates the combined effect of Alberta Stroke Program Early CT Score (ASPECTS) and age on very poor outcome in patients with large core infarction treated with EVT.
Methods This subanalysis of the MAGIC registry, which is a prospective, multicenter cohort study of early treatment in acute stroke, focused on patients with ASPECTS ≤5 presenting within 24 hours of stroke onset and receiving CT followed by EVT from November 1, 2021 to February 8, 2023. Multivariable logistic regression was used to investigate the independent and joint association of ASPECTS and age with very poor outcome.
Results Among the 490 patients (57.3% men; median (IQR) age 69 (59–78) years), very poor outcome occurred more frequently in those with lower ASPECTS (65.2% in ASPECTS 0–2 vs 43.4% in ASPECTS 3–5; P<0.001). The predictive value of successful recanalization for very poor outcome was significant in patients with ASPECTS 3–5 (P=0.010), but it diminished in those with ASPECTS 0–2 (P=0.547). Compared with patients with ASPECTS 3–5 and age ≤69 years, the risk of a very poor outcome increased incrementally in those with lower ASPECTS, advanced age, or both (P<0.05). Graphical plot analysis showed a significantly lower probability of very poor outcome in younger patients (≤69 years) compared with older patients (>69 years) across all ASPECTS points.
Conclusion These findings suggest prioritizing young patients as candidates for EVT in those with ASPECTS 0–2.
- Thrombectomy
- CT
- Intervention
- Stroke
Data availability statement
Data are available upon reasonable request.
Statistics from Altmetric.com
Data availability statement
Data are available upon reasonable request.
Footnotes
CG and JY are joint senior authors.
ZL, LL and ZP are joint first authors.
ZL, LL and ZP contributed equally.
Contributors ZL and JY had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. CG and JY contributed to study design, data analysis, data interpretation, and revised the draft manuscript. ZL, LL, ZP contributed to concept and design. ZL, SZ, XH, SF, XX, JM were involved in acquisition, analysis, or interpretation of data and drafting of the article. ZL obtained funding and was responsible for the overall content as the guarantor. CY, NY contributed to statistical analysis. CG and JY supervised the study.
Funding This study was funded by the Natural Science Research Project of Universities of Anhui Province in China (grant no. 2022AH051244), the Health Research Program of Anhui in China (grant no. AHWJ2022b090) and the Scientific Research Fund Project for Talent Introduction of Yijishan Hospital in China (grant no. YR202111).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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