Purpose

The aim of this study was to analyze sex differences in outcome after thrombectomy for acute ischemic stroke in clinical practice in a large prospective multicenter registry.

Methods

Data of consecutive stroke patients treated with thrombectomy (June 2015–April 2018) derived from an industry-independent registry (German Stroke Registry–Endovascular Treatment) were prospectively analyzed. Multivariable binary logistic regression analyses were applied to determine whether sex is a predictor of functional independence outcome (defined as a modified Rankin scale [mRS] 0–2) 90 days after stroke.

Results

In total, 2316 patients were included in the analysis, 1170 (50.5%) were female and 1146 (49.5%) were male. Women were older (median age 78 vs. 72 years; p < 0.001) and more frequently had a prestroke functional impairment defined by mRS >1 (24.8% vs. 14.1%; p < 0.001). In unadjusted analyses, independent outcome at 90 days was less frequent in women (33.2%) than men (40.6%; p < 0.001). Likewise, mortality was higher in women than in men (30.7% vs. 26.4%; p = 0.024). In adjusted regression analyses, however, sex was not associated with outcome. Lower age, a lower baseline National Institutes of Health Stroke Scale score, a higher Alberta Stroke Program Early CT score, prestroke functional independence, successful reperfusion, and concomitant intravenous thrombolysis therapy predicted independent outcome.

Conclusion

Women showed a worse functional outcome after thrombectomy for acute ischemic stroke in clinical practice; however, after adjustment for crucial confounders sex was not a predictor of outcome. The difference in outcome thus appears to result from differences in confounding factors such as age and prestroke functional status.

中文翻译：

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混杂因素解释了急性缺血性卒中血栓切除术后结局的性别差异

目的

本研究的目的是在大型前瞻性多中心登记的临床实践中分析急性缺血性卒中血栓切除术后结局的性别差异。

方法

前瞻性分析了来自行业独立登记处（德国卒中登记处-血管内治疗）的接受血栓切除术治疗的连续卒中患者的数据（2015 年 6 月至 2018 年 4 月）。应用多变量二元逻辑回归分析来确定性别是否是卒中后 90 天功能独立结果（定义为改良 Rankin 量表 [mRS] 0-2）的预测因子。

结果

共有 2316 名患者被纳入分析，其中 1170 名（50.5%）为女性，1146 名（49.5%）为男性。女性年龄较大（中位年龄 78 岁对 72 岁；p  < 0.001），并且更频繁地出现由 mRS > 1 定义的卒中前功能障碍（24.8% 对 14.1%；p  < 0.001）。在未经调整的分析中，女性 (33.2%) 的 90 天独立结局发生率低于男性 (40.6%；p  < 0.001)。同样，女性的死亡率高于男性（30.7% vs. 26.4%；p = 0.024)。然而，在调整后的回归分析中，性别与结果无关。较低的年龄、较低的基线美国国立卫生研究院卒中量表评分、较高的阿尔伯塔卒中计划早期 CT 评分、卒中前功能独立性、成功再灌注和伴随的静脉溶栓治疗可预测独立结果。

结论

在临床实践中，女性在急性缺血性卒中取栓后的功能结果较差；然而，在对关键混杂因素进行调整后，性别并不是结果的预测指标。因此，结果的差异似乎是由年龄和卒中前功能状态等混杂因素的差异造成的。