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Published on: February 26, 2013
Greater Severity of Neurological Defects in Women Admitted With Atrial Fibrillation-Related Stroke
Tomohisa Nezu1, Naohisa Hosomi, Keita Kondo
1Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical & Health Sciences.
Insights
Female sex is linked to more severe initial strokes in atrial fibrillation patients. This study identified key risk factors for stroke severity, highlighting sex as an independent predictor.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- The CHA2DS2-VASc score predicts stroke incidence and outcomes in atrial fibrillation (AF).
- The relationship between sex and initial stroke severity in AF-related cardioembolic stroke is not well understood.
- Understanding stroke severity predictors is crucial for patient management.
Purpose of the Study:
- To identify risk factors for initial stroke severity in patients with AF-related cardioembolic stroke.
- To investigate the association between sex and neurological deficits at stroke onset.
Main Methods:
- Analysis of 12,701 patients with AF-related cardioembolic stroke from a multicenter registry (Japan Standard Stroke Registry Study).
- Utilized multiple linear regression to identify indicators of National Institutes of Health Stroke Scale (NIHSS) scores at admission.
- Examined correlations between NIHSS scores and various clinical factors, including CHA2DS2-VASc score and sex.
Main Results:
- Higher NIHSS scores correlated with increased CHA2DS2-VASc score (ρ=0.197; P<0.001).
- Women experienced more severe initial neurological deficits than men (median NIHSS 14 vs. 8; P<0.001).
- Independent predictors of higher NIHSS scores included older age, female sex, diabetes, congestive heart failure, vascular disease, and prior stroke/TIA.
Conclusions:
- Female sex is an independent risk factor associated with greater initial neurological severity in cardioembolic stroke patients with AF.
- These findings underscore the importance of considering sex when assessing stroke severity in AF patients.
Background:
The magnitude of the CHA2DS2-VASc score is associated with not only stroke incidence but also long-term outcomes. The association between sex and initial stroke severity in AF-related cardioembolic stroke patients has not been clarified. The present study aimed to elucidate the risk factors for initial stroke severity among patients with cardioembolic stroke enrolled in a multicenter registry.
Methods And Results:
We selected 12,701 patients (age, 77±10 years; 5,653 women) with AF-related cardioembolic stroke from the Japan Standard Stroke Registry Study between January 2000 and July 2013. Indicators of National Institutes of Health Stroke Scale (NIHSS) scores at admission were identified using a multiple linear regression. Increased NIHSS scores positively correlated with CHA2DS2-VASc score (ρ=0.197; P<0.001). The initial neurological deficits were more severe in women than in men (NIHSS scores, median [interquartile range] 14 [5-22] vs. 8 [3-18]; P<0.001). Multiple regression analysis revealed that higher age (standardized partial regression coefficient [β] 0.162; P<0.001), female sex (β 0.120; P<0.001), diabetes mellitus (β 0.020; P=0.019), dyslipidemia (β -0.076; P<0.001), congestive heart failure (β 0.039; P<0.001), vascular disease (β 0.030; P=0.001), prior stroke/TIA (β 0.085; P<0.001) and prior anticoagulant use (β -0.020; P=0.028) were associated with the NIHSS score at admission.
Conclusions:
Female sex was independently associated with the initial neurological severity among AF-related cardioembolic stroke patients.
