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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Sex Differences and Functional Outcome After Intravenous Thrombolysis
Fianne H Spaander1, Sanne M Zinkstok1, Irem M Baharoglu1
1From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (F.H.S., S.M.Z., I.M.B., P.J.N.); Stroke Center and Department of Neurology, University Hospital Basel, Switzerland (H.G., A.P., C.T., S.T.E.); Department of Neurology, University Hospital Heidelberg, Germany (C.H., P.R.); Department of Neurology, Helsinki University Central Hospital, Finland (S.C., N.M.-M., K.A.); Department of Neurology and Center for Stroke Research, Charité-Universitätsmedizin Berlin, Germany (C.H.N., J.F.S.); University Lille, Inserm, CHU Lille, U1171-Degenerative and Vascular Cognitive Disorders, France (D.L., A.H.); Department of Neurology, Clinical Centre of Serbia, Beograd (V.P.); Department of Neurology, Kantonsspital St. Gallen, Switzerland (G.K.); Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy (A.P.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland (P.M., O.B.); and Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Italy (A.Z.).
Background And Purpose:
Women have a worse outcome after stroke compared with men, although in intravenous thrombolysis (IVT)-treated patients, women seem to benefit more. Besides sex differences, age has also a possible effect on functional outcome. The interaction of sex on the functional outcome in IVT-treated patients in relation to age remains complex. The purpose of this study was to compare outcome after IVT between women and men with regard to age in a large multicenter European cohort reflecting daily clinical practice of acute stroke care.
Methods:
Data were obtained from IVT registries of 12 European tertiary hospitals. The primary outcome was poor functional outcome, defined as a modified Rankin scale score of 3 to 6 at 3 months. We stratified outcome by age in decades. Safety measures were symptomatic intracranial hemorrhage and mortality at 3 months.
Results:
In this cohort, 9495 patients were treated with IVT, and 4170 (43.9%) were women with a mean age of 71.9 years. After adjustments for baseline differences, female sex remained associated with poor functional outcome (odds ratio, 1.15; 95% confidence interval, 1.02-1.31). There was no association between sex and functional outcome when data were stratified by age. Symptomatic intracranial hemorrhage rate was similar in both sexes (adjusted odds ratio, 0.93; 95% confidence interval, 0.73-1.19), whereas mortality was lower among women (adjusted odds ratio, 0.83; 95% confidence interval, 0.70-0.99).
Conclusions:
In this large cohort of IVT-treated patients, women more often had poor functional outcome compared with men. This difference was not dependent on age.
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