In-hospital outcomes of intravenous recombinant tissue plasminogen activator treatment for acute ischemic stroke in patients aged >80 years: Findings from the Chinese Stroke Center Alliance

Background: Intravenous (IV) recombinant plasminogen activator (rt-PA) within 4.5 hours of symptom onset has established benefit for patients with acute ischemic stroke (AIS); however, evidence on the use of IV rt-PA in elderly Chinese patients is limited. This study evaluated the patient characteristics and in-hospital clinical outcomes of Chinese patients aged >80 years who received IV rt-PA within 4.5 hours of symptom onset, using patients aged 18-80 years as a reference group. (NCT05395351).

Methods: This study analyzed adult Chinese patients with AIS who arrived at the hospital within 4.5 hours of symptom onset between August 2015 and July 2019 and were registered in the nationwide, hospital-based Chinese Stroke Center Alliance platform. Patients were categorized by treatment (IV rt-PA versus no IV rt-PA) and age (>80 years versus 18-80 years). In-hospital outcomes were evaluated in IV rt-PA-treated patients. Primary outcome was all-cause mortality during hospitalization; secondary outcomes included proportion of patients with intracranial hemorrhage (ICH) during hospitalization, change in National Institutes of Health Stroke Scale (NIHSS) before and 24 hours after IV rt-PA, modified Rankin Scale (mRS) at discharge, proportion of patients with stroke recurrence during hospitalization, and duration of hospital stay.

Results: Of 113035 patients with AIS included in the study, 31,418 patients received IV rt-PA within 4.5 hours after symptom onset (aged >80 years: n=3,332; 18-80 years: n=28,086). Among IV rt-PA-treated patients, all-cause mortality was 2.6% (95% CI 2.1-3.2%) and 0.8% (95% CI 0.7-0.9%) in patients aged >80 years and 18-80 years, respectively. Intracranial hemorrhage occurred in 6.7% (95% CI 5.8-7.5%) and 3.1% (95% CI 2.9-3.3%) of patients; mean±SD change in NIHSS score was 2.8±5.0 and 2.5±4.3; mRS 0-1 at discharge in 42.8% (95% CI 40.8%-44.8%) and 63.6% (95% CI 62.9%-64.3%); stroke recurrence in 11.1% (95% CI 10.0-12.1%) and 7.3% (95% CI 7.0-7.6%). Median duration of hospital stay was 11 days in both age groups.

Conclusions: Chinese patients aged >80 years with AIS who received IV rt-PA within 4.5 hours after symptom onset had higher all-cause mortality during hospitalization than those aged 18-80 years.