| Title: |
Mediation of Age and Thrombectomy Outcome by Neuroimaging Markers of Frailty in Patients With Stroke |
| Authors: |
Benali, Faysal; Singh, Nishita; Fladt, Joachim; Jaroenngarmsamer, Tanaporn; Bala, Fouzi; Ospel, Johanna M.; Buck, Brian H.; Dowlatshahi, Dar; Field, Thalia S.; Hanel, Ricardo A.; Peeling, Lissa; Tymianski, Michael; Hill, Michael D.; Goyal, Mayank; Ganesh, Aravind; Barber, Philip A.; Smith, Eric E.; Bal, Simerpreet; Subramanian, Suresh; Peters, Steven; Couillard, Philippe; Klein, Gary; Stys, Peter; Coutts, Shelagh B.; Wong, John; Mitha, Alim; Eesa, Muneer; Morrish, William; Alqatani, Saad; Kashani, Nima; Venkatesan, Prasanna; Teleg, Ericka; Sitaram, Amith; Graham, Brett; Gaal, Stephen van; Moussaddy, Aimen; Chakraborty, Debabrata; Maraj, Nicholar; Lockey, Andrew; Chen, Shuo; Singh, Ravinder; Alsultan, Abdulaziz Sulaiman; Asunsian, Ria; Tse, Dominic; Doshi, Darshan; Volny, Ondrej; Ojha, Piyush; Wadhwa, Ankur; Marko, Martha |
| Source: |
JAMA Network Open ; volume 7, issue 1, page e2349628 ; ISSN 2574-3805 |
| Publisher Information: |
American Medical Association (AMA) |
| Publication Year: |
2024 |
| Description: |
Importance Age is a leading predictor of poor outcomes after brain injuries like stroke. The extent to which age is associated with preexisting burdens of brain changes, visible on neuroimaging but rarely considered in acute decision-making or trials, is unknown. Objectives To explore the mediation of age on functional outcome by neuroimaging markers of frailty (hereinafter neuroimaging frailty) in patients with acute ischemic stroke receiving endovascular thrombectomy (EVT). Design, Setting, and Participants This cohort study was a post hoc analysis of the Safety and Efficacy of Nerinetide (NA-1) in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) randomized clinical trial, which investigated intravenous (IV) nerinetide in patients who underwent EVT within a 12-hour treatment window. Patients from 48 acute care hospitals in 8 countries (Canada, US, Germany, Korea, Australia, Ireland, UK, and Sweden) were enrolled between March 1, 2017, and August 12, 2019. Markers of brain frailty (brain atrophy [subcortical or cortical], white matter disease [periventricular or deep], and the number of lacunes and chronic infarctions) were retrospectively assessed while reviewers were blinded to other imaging (eg, computed tomography angiography, computed tomography perfusion) or outcome variables. All analyses were done between December 1, 2022, and January 31, 2023. Exposures All patients received EVT and were randomized to IV nerinetide (2.6 mg/kg of body weight) and alteplase (if indicated) treatment vs best medical management. Main Outcome and Measures The primary outcome was the proportion of the total effect of age on 90-day outcome, mediated by neuroimaging frailty. A combined mediation was also examined by clinical features associated with frailty and neuroimaging markers (total frailty). Structural equation modeling was used to create latent variables as potential mediators, adjusting for baseline, early ischemic changes; stroke severity; onset-to-puncture time; nerinetide treatment; and ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1001/jamanetworkopen.2023.49628 |
| Availability: |
https://doi.org/10.1001/jamanetworkopen.2023.49628; https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2813454/benali_2024_oi_231443_1703019077.00533.pdf |
| Accession Number: |
edsbas.CD29BDED |
| Database: |
BASE |