Frontiers in Aging Neuroscience (Jan 2024)

To what extent does frailty mediate the association between age and the outcomes of brain reperfusion following acute ischemic stroke?

  • Luana Aparecida Miranda,
  • Gustavo José Luvizutto,
  • Pedro Augusto Cândido Bessornia,
  • Natalia Eduarda Furlan,
  • Fernanda Cristina Winckler,
  • Natalia Cristina Ferreira,
  • Pedro Tadao Hamamoto Filho,
  • Juli Thomaz de Souza,
  • Luis Cuadrado Martin,
  • Silméia Garcia Zanati Bazan,
  • Gabriel Pinheiro Modolo,
  • Carlos Clayton Macedo de Freitas,
  • Edison Iglesias de Oliveira Vidal,
  • Rodrigo Bazan

DOI
https://doi.org/10.3389/fnagi.2024.1305803
Journal volume & issue
Vol. 16

Abstract

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ObjectiveWe evaluated the extent to which frailty mediated the association between age, poor functional outcomes, and mortality after acute ischemic stroke when patients were treated with brain reperfusion (thrombolytic therapy and/or thrombectomy).Materials and methodsThis retrospective cohort study included patients diagnosed with ischemic stroke who had undergone intravenous cerebral reperfusion therapy and/or mechanical thrombectomy. We created a mediation model by analyzing the direct natural effect of an mRS score > 2 and death on age-mediated frailty according to the Frailty Index.ResultsWe enrolled 292 patients with acute ischemic stroke who underwent brain reperfusion. Their mean age was 67.7 ± 13.1 years. Ninety days after the stroke ictus, 54 (18.5%) participants died, and 83 (28.4%) lived with moderate to severe disability (2 < mRS < 6). In the mediation analysis of the composite outcome of disability (mRS score > 2) or death, frailty accounted for 28% of the total effect of age. The models used to test for the interaction between age and frailty did not show statistically significant interactions for either outcome, and the addition of the interaction did not significantly change the direct or indirect effects, nor did it improve model fit.ConclusionFrailty mediated almost one-third of the effect of age on the composite outcome of disability or death after acute ischemic stroke.

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