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Frailty and comorbidity burden predict complications after mechanical thrombectomy in Octogenarians
Madeline Elizabeth Moore1, Najib Muhammad2, Alexander Gerlach2
1Department of Neurology, Albany Medical Center, Albany, NY, USA.
Summary
Comorbidity indices like Charlson Comorbidity Index (CCI) and modified Frailty Index (mFI) predict complications in elderly stroke patients undergoing mechanical thrombectomy. These tools aid risk stratification but have modest predictive power for mortality.
Area of Science:
- Neurology
- Geriatrics
- Health Services Research
Background:
- Comorbidity burden and physiological reserve significantly impact post-stroke outcomes in elderly patients.
- Evaluating predictive utility of comorbidity and risk indices is crucial for octogenarian mechanical thrombectomy patients.
Purpose of the Study:
- To assess the predictive value of Charlson Comorbidity Index (CCI), modified Frailty Index (mFI-5, mFI-11), and Risk Analysis Index (RAI, RAI-Rev) in octogenarian patients undergoing mechanical thrombectomy for middle cerebral artery (MCA) stroke.
Main Methods:
- Retrospective analysis of octogenarian patients (80-89 years) with MCA ischemic stroke who underwent mechanical thrombectomy using National Inpatient Sample (NIS) data.
- Primary outcome: in-hospital mortality. Secondary outcomes: procedural complications, non-home discharge, extended hospital stays, high-cost hospitalization.
- Receiver operating characteristic (ROC) curve analysis and multivariate regression models evaluated predictive performance and associations.
Main Results:
- Higher CCI, mFI-5, and mFI-11 scores correlated with increased odds of complications, extended hospital stays, non-home discharge, and higher costs (p < 0.001 for all).
- CCI was the only index significantly associated with in-hospital mortality (OR 1.075) and had the highest AUC (0.591), though predictive performance was modest.
- RAI and RAI-Rev showed limited prognostic utility for the evaluated outcomes.
Conclusions:
- Comorbidity indices (CCI, mFI-5, mFI-11) show stronger associations with post-thrombectomy complications and hospital outcomes than age alone in octogenarian MCA stroke patients.
- The modest predictive power, especially for mortality, indicates these indices are supplementary risk-stratification tools, not definitive decision thresholds.
- These indices can aid clinical risk stratification when used alongside neurological status, imaging, and patient goals of care.
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