Effect of treatment modality and cerebral vasospasm agent on patient outcomes after aneurysmal subarachnoid hemorrhage in the elderly aged 75 years and older

Keisuke Ido, Ryota Kurogi, Ai Kurogi, Kunihiro Nishimura, Koichi Arimura, Ataru Nishimura, Nice Ren, Akiko Kada, Ryu Matsuo, Daisuke Onozuka, Akihito Hagihara, So Takagishi, Keitaro Yamagami, Misa Takegami, Yasunobu Nohara, Naoki Nakashima, Masahiro Kamouchi, Isao Date, Takanari Kitazono, Koji Iihara

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Abstract

Objective We sought to examine whether the effect of treatment modality and drugs for cerebral vasospasm on clinical outcomes differs between elderly and non-elderly subarachnoid hemorrhage (SAH) patients in Japan. Methods We analyzed the J-ASPECT Study Diagnosis Procedure Combination database (n = 17,343) that underwent clipping or coiling between 2010 and 2014 in 579 hospitals. We stratified patients into two groups according to their age (elderly [≥75 years old], n = 3,885; non-elderly, n = 13,458). We analyzed the effect of treatment modality and anti-vasospasm agents (fasudil hydrochloride, ozagrel sodium, cilostazol, statin, eicosapentaenoic acid [EPA], and edaravone) on in-hospital poor outcomes (MRS 3-6 at discharge) and mortality using multivariable analysis. Results The elderly patients were more likely to be female, have impaired levels of consciousness and comorbidity, and less likely to be treated with clipping and anti-vasospasm agents, except for ozagrel sodium and statin. In-hospital mortality and poor outcomes were higher in the elderly (15.8% vs. 8.5%, 71.7% vs. 36.5%). Coiling was associated with higher mortality (odds ratio 1.43, 95% confidence interval 1.2-1.7) despite a lower proportion of poor outcomes (0.84, 0.75-0.94) in the non-elderly, in contrast to no effect on clinical outcomes in the elderly. A comparable effect of anti-vasospasm agents on mortality was observed between nonelderly and elderly for fasudil hydrochloride (non-elderly: 0.20, 0.17-0.24), statin (0.63, 0.50-0.79), ozagrel sodium (0.72, 0.60-0.86), and cilostazol (0.63, 0.51-0.77). Poor outcomes were inversely associated with fasudil hydrochloride (0.59, 0.51-0.68), statin (0.84, 0.75-0.94), and EPA (0.83, 0.72-0.94) use in the non-elderly. No effect of these agents on poor outcomes was observed in the elderly. Conclusions In contrast to the non-elderly, no effect of treatment modality on clinical outcomes were observed in the elderly. A comparable effect of anti-vasospasm agents was observed on mortality, but not on functional outcomes, between the non-elderly and elderly.

Original languageEnglish
Article numbere0230953
JournalPloS one
Volume15
Issue number4
DOIs
Publication statusPublished - Apr 2020

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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    Ido, K., Kurogi, R., Kurogi, A., Nishimura, K., Arimura, K., Nishimura, A., Ren, N., Kada, A., Matsuo, R., Onozuka, D., Hagihara, A., Takagishi, S., Yamagami, K., Takegami, M., Nohara, Y., Nakashima, N., Kamouchi, M., Date, I., Kitazono, T., & Iihara, K. (2020). Effect of treatment modality and cerebral vasospasm agent on patient outcomes after aneurysmal subarachnoid hemorrhage in the elderly aged 75 years and older. PloS one, 15(4), [e0230953]. https://doi.org/10.1371/journal.pone.0230953