Female Stroke: Sex Differences in Acute Treatment and Early Outcomes of Acute Ischemic Stroke.
Stroke
; 52(2): 406-415, 2021 01.
Article
em En
| MEDLINE
| ID: mdl-33493053
ABSTRACT
BACKGROUND AND PURPOSE:
Men and women are differently affected by acute ischemic stroke (AIS) in many aspects. Prior studies on sex disparities were limited by moderate sample sizes, varying years of data acquisition, and inconsistent inclusions of covariates leading to controversial findings. We aimed to analyze sex differences in AIS severity, treatments, and early outcome and to systematically evaluate the effect of important covariates in a large German stroke registry.METHODS:
Analyses were based on the Stroke Registry of Northwestern Germany from 2000 to 2018. We focused on admission-stroke severity and disability, acute recanalization treatment, and early stroke outcomes. Potential sex divergences were investigated via odds ratio (OR) using logistic regression models. Covariates were introduced in 3steps:
(1) base models (age and admission year), (2) partially adjusted models (additionally corrected for acute stroke severity and recanalization treatment), (3) fully adjusted models (additionally adjusted for onset-to-admission time interval, prestroke functional status, comorbidities, and stroke cause). Models were separately fitted for the periods 2000 to 2009 and 2010 to 2018.RESULTS:
Data from 761 106 patients with AIS were included. In fully adjusted models, there were no sex differences with respect to treatment with intravenous thrombolysis (2000-2009 OR, 0.99 [95% CI, 0.94-1.03]; 2010-2018 OR, 1.0 [0.98-1.02]), but women were more likely to receive intraarterial therapy (2010-2018 OR, 1.12 [1.08-1.15]). Despite higher disability on admission (2000-2009 OR, 1.10 [1.07-1.13]; 2010-2018 OR, 1.09 [1.07-1.10]), female patients were more likely to be discharged with a favorable functional outcome (2003-2009 OR, 1.05 [1.02-1.09]; 2010-2018 OR, 1.05 [1.04-1.07]) and experienced lower in-hospital mortality (2000-2009 OR, 0.92 [0.86-0.97]; 2010-2018 OR, 0.91 [0.88-0.93]).CONCLUSIONS:
Female patients with AIS have a higher chance of receiving intraarterial treatment that cannot be explained by clinical characteristics, such as age, premorbid disability, stroke severity, or cause. Women have a more favorable in-hospital recovery than men because their higher disability upon admission was followed by a lower in-hospital mortality and a higher likelihood of favorable functional outcome at discharge after adjustment for covariates.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Caracteres Sexuais
/
Resultado do Tratamento
/
AVC Isquêmico
Tipo de estudo:
Prognostic_studies
Limite:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Stroke
Ano de publicação:
2021
Tipo de documento:
Article