急性缺血性脑卒中患者静脉溶栓后功能预后的性别差异趋势。

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-09-02 DOI:10.1177/17474930241273696
Martha Marko, Dominika Miksova, Melanie Haidegger, Jakob Schneider, Johanna Ebner, Marie B Lang, Wolfgang Serles, Stefan Kiechl, Michael Knoflach, Marek Sykora, Julia Ferrari, Thomas Gattringer, Stefan Greisenegger
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引用次数: 0

摘要

背景:静脉溶栓(IVT)是一种获准用于急性缺血性脑卒中患者的治疗方法,与性别无关。然而,目前有关 IVT 治疗后功能预后性别差异的文献并不一致。迄今为止,一些研究(包括之前基于奥地利卒中单元登记(ASUR)数据的分析)发现了功能预后中与性别相关的显著差异,而另一些研究则未报告男女之间存在任何差异。目的:评估全国性大型队列中缺血性脑卒中功能预后性别差异的时间趋势,并研究女性和男性患者特征与溶栓后功能预后的关联。尽管急性中风治疗取得了巨大进步,但功能预后的性别差异是否仍然存在,这些数据将为我们提供重要的见解:我们分析了 2006 年至 2021 年间 ASUR 的 39 个卒中中心接受 IVT 治疗的急性缺血性卒中连续患者的回顾性数据。我们纳入了接受 IVT 治疗的 18 岁以上急性缺血性脑卒中患者,并提供了治疗后 3 个月的功能预后数据。主要结果参数是 3 个月后的良好功能预后(修正的 Rankin 量表 (mRS) 为 0-2)。研究人员对所有患者进行了多变量逻辑回归分析,并按性别进行了分层,以评估基线特征与功能预后的关系:结果:在接受IVT治疗的11840名患者中,2489/5503(45.4%)名女性获得了良好的功能预后,而男性为3787/6337(59.8%)名。总体而言,女性性别是预测溶栓后功能预后的一个具有统计学意义的因素,但预测预后的其他因素在女性和男性之间存在差异。女性性别与实现功能独立的机会减少独立相关(adjOR 0.87,95%CI 0.79-0.96,p=0.005),我们发现随着时间的推移,只有男性的功能预后有统计学意义的改善(治疗年,adjOR(每年)1.04,95%CI 1.02-1.06,p结论:过去几年中,急性缺血性脑卒中 IVT 治疗后功能预后的性别差异持续存在。我们的分析结果可以提高人们的认识,因此关注预后预测因素的性别差异有助于在未来减轻这些差异,支持在临床常规中对患者进行更个体化的护理。需要进行后续分析,以评估这一潜在影响及其在未来的效果:奥地利卒中单元登记处的数据只能由受雇的统计学家(DM)访问,访问查询必须向登记处的学术审查委员会提出。
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Trends in sex differences of functional outcome after intravenous thrombolysis in patients with acute ischemic stroke.

Background: Intravenous thrombolysis (IVT) is an approved treatment for patients with acute ischemic stroke irrespective of sex. However, the current literature on sex differences in functional outcomes following IVT is inconsistent. So far, a number of studies-including a previous analysis based on data from the Austrian Stroke Unit Registry (ASUR)-detected significant sex-related differences in functional outcome, while others did not report any differences between women and men. In addition, currently there is a lack of data on how sex-related differences evolve over time.

Aims: To assess time trends of sex-related differences in functional outcome of ischemic stroke in a large nationwide cohort and to investigate associations of patient characteristics with functional outcome post thrombolysis in women and men. These data will offer crucial insights into whether sex differences in functional outcome persist despite the large advances in acute stroke treatment.

Methods: We analyzed retrospective data of consecutive patients with acute ischemic stroke treated with IVT in 39 stroke centers contributing to the ASUR between 2006 and 2021. We included patients over 18 years of age diagnosed with an acute ischemic stroke who received IVT and with available data on functional outcome at 3 months after treatment. The primary outcome parameter was favorable functional outcome (modified Rankin Scale (mRS) of 0-2) at 3 months. Multivariable logistic regression analysis was performed in the overall population and stratified by sex to assess associations of baseline characteristics with functional outcome.

Results: Among 11,840 patients receiving IVT, 2489 of 5503 (45.4%) women achieved favorable functional outcome compared to 3787 of 6337 (59.8%) men. Overall, female sex was a statistically significant predictor of functional outcome after thrombolysis, but additional predictors of outcome differed between women and men. Female sex was independently associated with decreased chances of achieving functional independency (adjusted odds ratio (adjOR) = 0.87, 95% confidence interval (CI) = 0.79-0.96, p = 0.005) and we detected a statistically significant improvement in functional outcome over time only in men (year of treatment, adjOR (per year) = 1.04, 95% CI = 1.02-1.06, p < 0.001) but not in women (adjOR (per year) = 1.01, 95% CI = 0.99-1.03, p = 0.280). Hypertension, smoking, and longer or unknown onset-to-door times were statistically significant predictors of outcome only in male patients, whereas atrial fibrillation, prior myocardial infarction, and longer door-to-needle times were significantly associated with outcome only in women.

Conclusions: Sex differences in functional outcome after IVT for acute ischemic stroke are persisting over the past years. Results of our analysis can increase awareness and a resulting focus on sex differences in predictors of outcome could be helpful in mitigating these differences in the future by supporting a more individualized patient care in clinical routine. Follow-up analyses are needed to assess this potential impact and its effect in the future.

Data access statement: Data from the Austrian Stroke Unit Registry can only be accessed by the employed statistician (D.M.), access inquiries have to be addressed to the registry's academic review board.

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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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