The Association of Gender with Functional Outcome in Thrombolysed Stroke: A Secondary Analysis of INTRECIS Study

Overview

Journal Heliyon

Specialty Social Sciences

Date 2024 Jul 4

PMID 38961923

Authors

Tong Chen

Yu Cui

Hui-Sheng Chen

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Sex differences in acute ischemic stroke have been widely investigated, but the difference in acute ischemic stroke patients who received intravenous thrombolysis is not well understood. The current study was to investigate the issue based on a prospective cohort.

Methods: From the Intravenous Thrombolysis Registry for Chinese Ischemic Stroke within 4.5h onset (INTRECIS) cohort, a total of 953 eligible patients with acute ischemic stroke were enrolled in final analysis. Based on 3-month modified Rankin scale score (mRS), patients were classified into good outcome group (mRS 0-1) and poor outcome group (mRS 2-6). Univariate and multivariate logistic regression analyses were used to identify predictive factors for clinical outcome in male or female patients.

Results: Of the 953 patients treated with intravenous thrombolysis, 314 (32.9 %) were women. At day 90, we found no significant gender differences in good outcome (72.5 % vs 65.6 %, adjusted p = 0.414). We got the same results after propensity score matching (69.5 % vs 63.4 %, adjusted p = 0.637). Furthermore, we found that initial National Institute of Health Stroke Scale (NIHSS) score (odd ratio [OR] 0.877; 95 % CI 0.847-0.909, p < 0.001) and serum creatinine (OR 0.993; 95 % CI 0.986-1.000, p = 0 0.043) were found to be independent risk factors for poor outcome in male patients, while initial NIHSS score (OR 0.879; 95 % CI 0.839-0.920, p < 0.001), age (OR 0.970; 95 % CI 0.946-0.995, p = 0.017), systolic blood pressure (OR 0.984; 95 % CI 0.972-0.996, p = 0.007) and small artery occlusion (OR 2.718; 95 % CI 1.065-6.936, p = 0.036) in female patients.

Conclusions: In this study, we found no gender difference in clinical outcome of thrombolysed stroke patients, but a difference in risk factors predicting outcome in male vs female patients was identified for the first time.

References

Elkind M, Prabhakaran S, Pittman J, Koroshetz W, Jacoby M, JOHNSTON K . Sex as a predictor of outcomes in patients treated with thrombolysis for acute stroke. Neurology. 2007; 68(11):842-8. DOI: 10.1212/01.wnl.0000256748.28281.ad. View

Mainz J, Andersen G, Valentin J, Gude M, Johnsen S . Disentangling Sex Differences in Use of Reperfusion Therapy in Patients With Acute Ischemic Stroke. Stroke. 2020; 51(8):2332-2338. DOI: 10.1161/STROKEAHA.119.028589. View

Heuschmann P, Kolominsky-Rabas P, Roether J, Misselwitz B, Lowitzsch K, Heidrich J . Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy. JAMA. 2004; 292(15):1831-8. DOI: 10.1001/jama.292.15.1831. View

Wang X, Li X, Xu Y, Li R, Yang Q, Zhao Y . Effectiveness of intravenous r-tPA versus UK for acute ischaemic stroke: a nationwide prospective Chinese registry study. Stroke Vasc Neurol. 2021; 6(4):603-609. PMC: 8717806. DOI: 10.1136/svn-2020-000640. View

Spaander F, Zinkstok S, Baharoglu I, Gensicke H, Polymeris A, Traenka C . Sex Differences and Functional Outcome After Intravenous Thrombolysis. Stroke. 2017; 48(3):699-703. DOI: 10.1161/STROKEAHA.116.014739. View

Lorenzano S, Ahmed N, Falcou A, Mikulik R, Tatlisumak T, Roffe C . Does sex influence the response to intravenous thrombolysis in ischemic stroke?: answers from safe implementation of treatments in Stroke-International Stroke Thrombolysis Register. Stroke. 2013; 44(12):3401-6. DOI: 10.1161/STROKEAHA.113.002908. View

Kent D, Price L, Ringleb P, Hill M, Selker H . Sex-based differences in response to recombinant tissue plasminogen activator in acute ischemic stroke: a pooled analysis of randomized clinical trials. Stroke. 2004; 36(1):62-5. DOI: 10.1161/01.STR.0000150515.15576.29. View

Li Z, Liu J, Shen J, Chen Y, He L, Li M . Sex-specific cardiac and vascular responses to hypertension in Chinese populations without overt cardiovascular diseases. Postgrad Med. 2020; 133(2):181-187. DOI: 10.1080/00325481.2020.1835037. View

Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D . Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008; 359(13):1317-29. DOI: 10.1056/NEJMoa0804656. View

10.

Nyasavajjala S, Phillips B, Lund J, Williams J . Creatinine and myoglobin are poor predictors of anaerobic threshold in colorectal cancer and health. J Cachexia Sarcopenia Muscle. 2015; 6(2):125-31. PMC: 4458078. DOI: 10.1002/jcsm.12020. View

11.

Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick J . Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004; 363(9411):768-74. DOI: 10.1016/S0140-6736(04)15692-4. View

12.

Kain K, Carter A, Bamford J, Grant P, Catto A . Gender differences in coagulation and fibrinolysis in white subjects with acute ischemic stroke. J Thromb Haemost. 2003; 1(2):390-2. DOI: 10.1046/j.1538-7836.2003.00040.x. View

13.

Reeves M, Bushnell C, Howard G, Gargano J, Duncan P, Lynch G . Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008; 7(10):915-26. PMC: 2665267. DOI: 10.1016/S1474-4422(08)70193-5. View

14.

Ospel J, Schaafsma J, Leslie-Mazwi T, Amin-Hanjani S, Asdaghi N, Gordon-Perue G . Toward a Better Understanding of Sex- and Gender-Related Differences in Endovascular Stroke Treatment: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke. 2022; 53(8):e396-e406. DOI: 10.1161/STR.0000000000000411. View

15.

Saver J, Fonarow G, Smith E, Reeves M, Grau-Sepulveda M, Pan W . Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA. 2013; 309(23):2480-8. DOI: 10.1001/jama.2013.6959. View

16.

Behl C . Oestrogen as a neuroprotective hormone. Nat Rev Neurosci. 2002; 3(6):433-42. DOI: 10.1038/nrn846. View

17.

Ingall T, OFallon W, Asplund K, Goldfrank L, Hertzberg V, Louis T . Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke. 2004; 35(10):2418-24. DOI: 10.1161/01.STR.0000140891.70547.56. View

18.

Weimar C, Konig I, Kraywinkel K, Ziegler A, Diener H . Age and National Institutes of Health Stroke Scale Score within 6 hours after onset are accurate predictors of outcome after cerebral ischemia: development and external validation of prognostic models. Stroke. 2003; 35(1):158-62. DOI: 10.1161/01.STR.0000106761.94985.8B. View

19.

Gebara O, Mittleman M, Sutherland P, Lipinska I, Matheney T, Xu P . Association between increased estrogen status and increased fibrinolytic potential in the Framingham Offspring Study. Circulation. 1995; 91(7):1952-8. DOI: 10.1161/01.cir.91.7.1952. View

20.

Perry A, Wang X, Goldberg R, Ross R, Jackson L . The relationship between cardiometabolic and hemostatic variables: influence of race. Metabolism. 2008; 57(2):200-6. DOI: 10.1016/j.metabol.2007.09.001. View