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; J-ASPECT Study Collaborators

doi:10.1371/journal.pone.0230953

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. 2020 Apr 9;15(4):e0230953. doi: 10.1371/journal.pone.0230953. eCollection 2020.

Authors

Keisuke Ido¹, Ryota Kurogi¹, Ai Kurogi¹, Kunihiro Nishimura², Koichi Arimura¹, Ataru Nishimura¹, Nice Ren¹, Akiko Kada³, Ryu Matsuo⁴, Daisuke Onozuka², Akihito Hagihara², So Takagishi¹, Keitaro Yamagami¹, Misa Takegami², Yasunobu Nohara⁵, Naoki Nakashima⁶, Masahiro Kamouchi⁴, Isao Date⁷, Takanari Kitazono⁸, Koji Iihara¹; J-ASPECT Study Collaborators

Affiliations

¹ Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
² Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan.
³ Department of Clinical Research Management, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
⁴ Department of Health Communication, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁵ Faculty of Advanced Science and Technology, Kumamoto University, Kumamoto, Japan.
⁶ Medical Information Center, Kyushu University Hospital, Fukuoka, Japan.
⁷ Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan.
⁸ Department of Medicine and Clinical Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.

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 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.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Female
Hospital Mortality
Humans
Japan
Male
Middle Aged
Odds Ratio
Subarachnoid Hemorrhage / drug therapy*
Treatment Outcome
Vasoconstriction / drug effects*
Vasodilator Agents / therapeutic use*
Vasospasm, Intracranial / drug therapy*

Substances

Vasodilator Agents

Grants and funding

Funding: The J-ASPECT Study (principal investigator: Koji Iihara) was supported by Grants-in-Aid from the Japanese Ministry of Health, Labour and Welfare and a KAKENHI grant (25293314, 18H02914) from the Japan Society for the Promotion of Science. This research is partially supported by the Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes Mellitus managed by the Japan Agency for Medical Research and Development (17ek0210088h0001, 18ek0210088h0002).