Safety, Functional Disability, Healthcare Utilization, and Quality-of-Life Outcomes in Elderly Receiving Alteplase and Tenecteplase: A Secondary Analysis From the AcT Trial
Bibliographic record
Abstract
BACKGROUND: Older age has been associated with overall poorer outcomes in acute ischemic stroke. We compared (1) outcomes in various health-related domains among patients <80 years and ≥80 years presenting with acute ischemic stroke and (2) whether outcomes differ between intravenous TNK (tenecteplase) versus alteplase. METHODS: Data are from patients included in AcT (Alteplase Compared to Tenecteplase in Patients With Acute Ischemic Stroke), a pragmatic, registry-linked, phase 3 randomized controlled trial comparing TNK with alteplase. Outcomes included functional disability (per 90-day modified Rankin Scale), safety (24-hour symptomatic intracerebral hemorrhage, 90-day mortality rates), health care utilization (discharge destination, length of stay, thrombectomy rate), and quality of life measures (EQ-5D-5L [EuroQol 5-Dimension 5-Level Scale]). With an a priori plan, patients aged <80 years were compared with those ≥80 years at symptom onset. Mixed effects Poisson regression was used to assess (1) the association of age with outcomes and (2) if these associations were modified by thrombolytic administered (TNK versus alteplase), after adjusting for sex, and baseline stroke severity. RESULTS: Of the 1577 patients, 1034 (65.6%; 520: TNK and 514: alteplase) were <80 years and 543 (34.4%; 286: TNK and 257: alteplase) were ≥80 years of age. Baseline characteristics in the 2 groups were similar except for sex 40% female in <80 years group versus 62.8% female in ≥80 years. There was no difference in rates of symptomatic intracranial hemorrhage (3.5% versus 3.1%). Patients in the ≥80 years group had significantly lower rates of excellent functional outcome, return to baseline status, higher mortality, and lower quality-of-life outcomes as compared with the <80 years group. Length of hospital stay was similar between the 2 groups but, patients in the ≥80 years age group had significantly lower rates of endovascular treatment utilization. Type of thrombolytic agent (TNK versus alteplase) did not modify the association between age and primary clinical outcome ( P interaction =0.22). CONCLUSIONS: Similar to alteplase, increasing age was associated with poorer functional outcomes with TNK. Rates of angiographic and bleeding outcomes were similar between patients <80 and ≥80 years. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03889249.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.005 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".