Frailty and stroke thrombectomy outcomes—an observational cohort study

Joyce, N. et al. (2022) Frailty and stroke thrombectomy outcomes—an observational cohort study. Age and Ageing, 51(2), afab260. (doi: 10.1093/ageing/afab260) (PMID:35150584)

[img] Text
265730.pdf - Accepted Version

618kB

Abstract

Introduction: Mechanical thrombectomy (MT) can improve outcomes following ischaemic stroke. Patient selection for MT is predominantly based on physiological and imaging parameters. We assessed whether people living with pre-stroke frailty had differing outcomes following MT. Methods: We included consecutive patients undergoing MT at a UK comprehensive stroke centre. We calculated a cumulative deficits frailty index to identify pre-stroke frailty in those patients presenting directly to the centre. Frailty was defined as an index score ≥ 0.24. We assessed univariable and multivariable association between pre-stroke frailty and stroke outcomes. Our primary outcomes were modified Rankin Scale (mRS) and mortality at 90 days. Results: Of 175 patients who underwent MT (2014–2018), we identified frailty in 49 (28%). Frail and non-frail patients had similar rates of thrombolysis administration, successful recanalization and onset to recanalization times. Those with pre-stroke frailty had higher 24 hour National Institutes of Health Stroke Scale (12(IQR: 8–17) versus 3(IQR: 2–13); P = 0.001); were less likely to be independent (mRS 0–2: 18% versus 61%; P < 0.001) and more likely to die (47% versus 14%; P < 0.001) within 90 days. Adjusting for age, baseline NIHSS and thrombolysis, frailty remained a strong, independent predictor of poor clinical outcome at 90 days (Death OR: 3.12 (95% CI: 1.32–7.4); dependency OR: 3.04 (95%CI: 1.10–8.44). Age was no longer a predictor of outcome when adjusted for frailty. Conclusion: Pre-stroke frailty is prevalent in real-world patients eligible for MT and is an important predictor of poor outcomes. Routine assessment of pre-stroke frailty could help decision-making around patient selection for MT.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Quinn, Professor Terry and Taylor-Rowan, Dr Martin
Authors: Joyce, N., Atkinson, T., Mc Guire, K., Wiggam, M. I., Gordon, P. L., Kerr, E. L., Patterson, C. E., McILmoyle, J., Roberts, G. E., Flynn, P. A., Burns, P., Rennie, I. R., Taylor-Rowan, M., Quinn, T. J., and Fearon, P.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
Journal Name:Age and Ageing
Publisher:Oxford University Press
ISSN:0002-0729
ISSN (Online):1468-2834
Published Online:12 February 2022
Copyright Holders:Copyright © The Author(s) 2022
First Published:First published in Age and Ageing 51(2): afab260
Publisher Policy:Reproduced in accordance with the publisher copyright policy

University Staff: Request a correction | Enlighten Editors: Update this record