Combined Effect of Age and Baseline Alberta Stroke Program Early Computed Tomography Score on Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry

Johanna Ospel; Manon Kappelhof; Adrien E. Groot; Natalie E. LeCouffe; Jonathan M. Coutinho; Albert J. Yoo; Lonneke S. F. Yo; Ludo F. M. Beenen; Wim H. van Zwam; Aad van der Lugt; Alida A. Postma; Yvo B. W. E. M. Roos; Mayank Goyal; Charles B. L. M. Majoie; MR CLEAN Registry Investigators; Robert Jan van Oostenbrugge

doi:10.1161/STROKEAHA.120.031773

Combined Effect of Age and Baseline Alberta Stroke Program Early Computed Tomography Score on Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry

Johanna Ospel, Manon Kappelhof, Adrien E. Groot, Natalie E. LeCouffe, Jonathan M. Coutinho, Albert J. Yoo, Lonneke S. F. Yo, Ludo F. M. Beenen, Wim H. van Zwam, Aad van der Lugt, Alida A. Postma, Yvo B. W. E. M. Roos, Mayank Goyal, Charles B. L. M. Majoie^*, MR CLEAN Registry Investigators, Robert Jan van Oostenbrugge

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background and Purpose:

Ischemic brain tissue damage in patients with acute ischemic stroke, as measured by the Alberta Stroke Program Early CT Score (ASPECTS) may be more impactful in older than in younger patients, although this has not been studied. We aimed to investigate a possible interaction effect between age and ASPECTS on functional outcome in acute ischemic stroke patients undergoing endovascular treatment, and compared reperfusion benefit across age and ASPECTS subgroups.

Methods:

Patients with ischemic stroke from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; March 2014-November 2017) were included. Multivariable ordinal logistic regression was performed to obtain effect size estimates (adjusted common odds ratio) on functional outcome (modified Rankin Scale score) for continuous age and granular ASPECTS, with a 2-way multiplicative interaction term (agexASPECTS). Outcomes in four patient subgroups based on age (<versus >= median age [71.8 years]) and baseline ASPECTS (6-10 versus 0-5) were assessed.

Results:

We included 3279 patients. There was no interaction between age and ASPECTS on modified Rankin Scale (P=0.925). The highest proportion of modified Rankin Scale 5 to 6 was observed in patients >71.8 years with baseline ASPECTS 0 to 5 (68/107, 63.6%). There was benefit of reperfusion in all age-ASPECTS subgroups. Although the adjusted common odds ratio was lower in patients >71.8 years with ASPECTS 0 to 5 (adjusted common odds ratio, 1.60 [95% CI, 0.66-3.88], n=110), there was no significant difference from the main effect (P=0.299).

Conclusions:

Although the proportion of poor outcomes following endovascular treatment was highest in older patients with low baseline ASPECTS, outcomes did not significantly differ from the main effect. These results do not support withholding endovascular treatment based n a combination of high age and low ASPECTS.

Original language	English
Pages (from-to)	3742-3745
Number of pages	4
Journal	Stroke
Volume	51
Issue number	12
DOIs	https://doi.org/10.1161/STROKEAHA.120.031773
Publication status	Published - Dec 2020

Keywords

odds ratio
registries
reperfusion
thrombectomy
tomography

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10.1161/STROKEAHA.120.031773

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Cite this

Ospel, J., Kappelhof, M., Groot, A. E., LeCouffe, N. E., Coutinho, J. M., Yoo, A. J., Yo, L. S. F., Beenen, L. F. M., van Zwam, W. H., van der Lugt, A., Postma, A. A., Roos, Y. B. W. E. M., Goyal, M., Majoie, C. B. L. M., MR CLEAN Registry Investigators, & van Oostenbrugge, R. J. (2020). Combined Effect of Age and Baseline Alberta Stroke Program Early Computed Tomography Score on Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry. Stroke, 51(12), 3742-3745. https://doi.org/10.1161/STROKEAHA.120.031773

@article{c1ed430146e64ac486f2d07a132fad82,

title = "Combined Effect of Age and Baseline Alberta Stroke Program Early Computed Tomography Score on Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry",

abstract = "Background and Purpose:Ischemic brain tissue damage in patients with acute ischemic stroke, as measured by the Alberta Stroke Program Early CT Score (ASPECTS) may be more impactful in older than in younger patients, although this has not been studied. We aimed to investigate a possible interaction effect between age and ASPECTS on functional outcome in acute ischemic stroke patients undergoing endovascular treatment, and compared reperfusion benefit across age and ASPECTS subgroups.Methods:Patients with ischemic stroke from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; March 2014-November 2017) were included. Multivariable ordinal logistic regression was performed to obtain effect size estimates (adjusted common odds ratio) on functional outcome (modified Rankin Scale score) for continuous age and granular ASPECTS, with a 2-way multiplicative interaction term (agexASPECTS). Outcomes in four patient subgroups based on age (= median age [71.8 years]) and baseline ASPECTS (6-10 versus 0-5) were assessed.Results:We included 3279 patients. There was no interaction between age and ASPECTS on modified Rankin Scale (P=0.925). The highest proportion of modified Rankin Scale 5 to 6 was observed in patients >71.8 years with baseline ASPECTS 0 to 5 (68/107, 63.6%). There was benefit of reperfusion in all age-ASPECTS subgroups. Although the adjusted common odds ratio was lower in patients >71.8 years with ASPECTS 0 to 5 (adjusted common odds ratio, 1.60 [95% CI, 0.66-3.88], n=110), there was no significant difference from the main effect (P=0.299).Conclusions:Although the proportion of poor outcomes following endovascular treatment was highest in older patients with low baseline ASPECTS, outcomes did not significantly differ from the main effect. These results do not support withholding endovascular treatment based n a combination of high age and low ASPECTS.",

keywords = "odds ratio, registries, reperfusion, thrombectomy, tomography",

author = "Johanna Ospel and Manon Kappelhof and Groot, {Adrien E.} and LeCouffe, {Natalie E.} and Coutinho, {Jonathan M.} and Yoo, {Albert J.} and Yo, {Lonneke S. F.} and Beenen, {Ludo F. M.} and {van Zwam}, {Wim H.} and {van der Lugt}, Aad and Postma, {Alida A.} and Roos, {Yvo B. W. E. M.} and Mayank Goyal and Majoie, {Charles B. L. M.} and {MR CLEAN Registry Investigators} and {van Oostenbrugge}, {Robert Jan}",

year = "2020",

month = dec,

doi = "10.1161/STROKEAHA.120.031773",

language = "English",

volume = "51",

pages = "3742--3745",

journal = "Stroke",

issn = "0039-2499",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "12",

}

Ospel, J, Kappelhof, M, Groot, AE, LeCouffe, NE, Coutinho, JM, Yoo, AJ, Yo, LSF, Beenen, LFM, van Zwam, WH, van der Lugt, A, Postma, AA, Roos, YBWEM, Goyal, M, Majoie, CBLM, MR CLEAN Registry Investigators & van Oostenbrugge, RJ 2020, 'Combined Effect of Age and Baseline Alberta Stroke Program Early Computed Tomography Score on Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry', Stroke, vol. 51, no. 12, pp. 3742-3745. https://doi.org/10.1161/STROKEAHA.120.031773

TY - JOUR

T1 - Combined Effect of Age and Baseline Alberta Stroke Program Early Computed Tomography Score on Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry

AU - Ospel, Johanna

AU - Kappelhof, Manon

AU - Groot, Adrien E.

AU - LeCouffe, Natalie E.

AU - Coutinho, Jonathan M.

AU - Yoo, Albert J.

AU - Yo, Lonneke S. F.

AU - Beenen, Ludo F. M.

AU - van Zwam, Wim H.

AU - van der Lugt, Aad

AU - Postma, Alida A.

AU - Roos, Yvo B. W. E. M.

AU - Goyal, Mayank

AU - Majoie, Charles B. L. M.

AU - MR CLEAN Registry Investigators

AU - van Oostenbrugge, Robert Jan

PY - 2020/12

Y1 - 2020/12

N2 - Background and Purpose:Ischemic brain tissue damage in patients with acute ischemic stroke, as measured by the Alberta Stroke Program Early CT Score (ASPECTS) may be more impactful in older than in younger patients, although this has not been studied. We aimed to investigate a possible interaction effect between age and ASPECTS on functional outcome in acute ischemic stroke patients undergoing endovascular treatment, and compared reperfusion benefit across age and ASPECTS subgroups.Methods:Patients with ischemic stroke from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; March 2014-November 2017) were included. Multivariable ordinal logistic regression was performed to obtain effect size estimates (adjusted common odds ratio) on functional outcome (modified Rankin Scale score) for continuous age and granular ASPECTS, with a 2-way multiplicative interaction term (agexASPECTS). Outcomes in four patient subgroups based on age (= median age [71.8 years]) and baseline ASPECTS (6-10 versus 0-5) were assessed.Results:We included 3279 patients. There was no interaction between age and ASPECTS on modified Rankin Scale (P=0.925). The highest proportion of modified Rankin Scale 5 to 6 was observed in patients >71.8 years with baseline ASPECTS 0 to 5 (68/107, 63.6%). There was benefit of reperfusion in all age-ASPECTS subgroups. Although the adjusted common odds ratio was lower in patients >71.8 years with ASPECTS 0 to 5 (adjusted common odds ratio, 1.60 [95% CI, 0.66-3.88], n=110), there was no significant difference from the main effect (P=0.299).Conclusions:Although the proportion of poor outcomes following endovascular treatment was highest in older patients with low baseline ASPECTS, outcomes did not significantly differ from the main effect. These results do not support withholding endovascular treatment based n a combination of high age and low ASPECTS.

AB - Background and Purpose:Ischemic brain tissue damage in patients with acute ischemic stroke, as measured by the Alberta Stroke Program Early CT Score (ASPECTS) may be more impactful in older than in younger patients, although this has not been studied. We aimed to investigate a possible interaction effect between age and ASPECTS on functional outcome in acute ischemic stroke patients undergoing endovascular treatment, and compared reperfusion benefit across age and ASPECTS subgroups.Methods:Patients with ischemic stroke from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; March 2014-November 2017) were included. Multivariable ordinal logistic regression was performed to obtain effect size estimates (adjusted common odds ratio) on functional outcome (modified Rankin Scale score) for continuous age and granular ASPECTS, with a 2-way multiplicative interaction term (agexASPECTS). Outcomes in four patient subgroups based on age (= median age [71.8 years]) and baseline ASPECTS (6-10 versus 0-5) were assessed.Results:We included 3279 patients. There was no interaction between age and ASPECTS on modified Rankin Scale (P=0.925). The highest proportion of modified Rankin Scale 5 to 6 was observed in patients >71.8 years with baseline ASPECTS 0 to 5 (68/107, 63.6%). There was benefit of reperfusion in all age-ASPECTS subgroups. Although the adjusted common odds ratio was lower in patients >71.8 years with ASPECTS 0 to 5 (adjusted common odds ratio, 1.60 [95% CI, 0.66-3.88], n=110), there was no significant difference from the main effect (P=0.299).Conclusions:Although the proportion of poor outcomes following endovascular treatment was highest in older patients with low baseline ASPECTS, outcomes did not significantly differ from the main effect. These results do not support withholding endovascular treatment based n a combination of high age and low ASPECTS.

KW - odds ratio

KW - registries

KW - reperfusion

KW - thrombectomy

KW - tomography

U2 - 10.1161/STROKEAHA.120.031773

DO - 10.1161/STROKEAHA.120.031773

M3 - Article

C2 - 33092478

SN - 0039-2499

VL - 51

SP - 3742

EP - 3745

JO - Stroke

JF - Stroke

IS - 12

ER -