Abstract
ObjectiveWe 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.MethodsWe 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.ResultsThe 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 non-elderly 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.ConclusionsIn 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.
Highlights
The incidence of subarachnoid hemorrhage (SAH) increases with advancing age [1,2]
Previous studies have reported the effect of fasudil hydrochloride [8.9], ozagrel sodium [10], cilostazol [11], statin [12], eicosapentaenoic acid (EPA) [13] and edaravone [14], but not on the clinical outcomes, on cerebral vasospasm following aneurysmal SAH (aSAH) mainly in the non-elderly population
In-hospital mortality and the proportion of poor outcomes at discharge were higher in the elderly group
Summary
The elderly patients with aneurysmal SAH (aSAH) have a greater risk of complications and poor outcomes than the risk in non-elderly patients due to worse clinical status on admission, less active management, and a higher frequency of comorbidity [2,3]. Elderly patients with aSAH are increasingly receiving definitive treatment due to an increased proportion of those with premorbid high activities of daily living and recent progress of endovascular therapy [4]. Previous studies have reported the effect of fasudil hydrochloride [8.9], ozagrel sodium [10], cilostazol [11], statin [12], eicosapentaenoic acid (EPA) [13] and edaravone [14], but not on the clinical outcomes, on cerebral vasospasm following aSAH mainly in the non-elderly population. The effects of these drug therapies for cerebral vasospasm and ischemia on the clinical outcome in elderly patients have not been elucidated
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