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, 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

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.

Conflict of interest statement

Dr. Iihara reports grants from grants from Otsuka Pharmaceutical Co., Ltd., grants from Kaneka Medix Corporation, grants from Eisai Co., Ltd., grants from Mitsubishi Tanabe Pharma Co., personal fees from Otsuka Pharmaceutical Co., Ltd., personal fees from Daiichi Sankyo Ltd, outside the submitted work; Dr. Kitazono reports grants from Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceuticals Co., Ltd, Mitsubishi Tanabe Pharma Co., Daiichi Sankyo Co., Ltd, Astellas Pharma Inc., MSD KK., and Shionogi & CO., LTD. Dr. Kamouchi reports personal fe 1 es from Daiichi Sankyo Co., Ltd, Ono pharmaceutical Co., Ltd., Bayer Yakuhin, Ltd., and Pfizer Co., Ltd.. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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Source: PubMed

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