Age differences in utilization and outcomes of tissue-plasminogen activator and mechanical thrombectomy in acute ischemic stroke

Background and purpose: U.S. demographics is shifting towards older population. Older stroke patients likely receive less tissue-plasminogen activator (t-PA) and mechanical thrombectomy (MT) compared to younger patients. The objective of this study is to evaluate extent of difference in utilization of t-PA and MT and outcomes of stroke between three age groups -18-45 (young adults), 46-80 (middle/old), and > 80 (oldest old) years. Methods: It is a retrospective cross-sectional observational study. Primary outcomes were rates of stroke intervention and effect of age on stroke intervention. Secondary outcomes were in-hospital mortality, discharge to home, and prolonged length of stay. Multivariate survey-logistic regression was performed to evaluate outcomes. Results: Among 487,105 patients in the study 4.8% were young adults, 66.6% middle/old, and 28.6% oldest old. Compared to young adults, middle/old received 19% (OR = 0.81; 95%CI = 0.72-0.91) less t-PA alone; and 33% (OR = 0.67; 95%CI = 0.53-0.83) less MT alone; oldest old received 25% less t-PA alone (OR = 0.75; 95%CI = 0.66-0.86) and 51% (OR = 0.49; 95%CI = 0.38-0.63) less MT alone. Compared to young adults, in-hospital mortality was three-fold higher among middle/old (OR = 3.5; 95%CI = 1.3-9.6), and seven-fold higher among oldest old (OR = 7.5; 95%CI = 2.8-20.5) for t-PA alone; discharge to home reduced by 40% in middle/old (OR = 0.6; 95%CI = 0.4-0.7) and by 80% in oldest old (OR = 0.2; 95%CI = 0.1-0.2) for t-PA alone and similarly for MT alone. Conclusions: Oldest old receive one-fourth less t-PA and half less MT compared to young adults. Oldest old patients who received t-PA alone or MT alone had remarkably worse outcomes for in-hospital mortality and discharge to home than young adults did.