Sex Differences in Outcome After Thrombectomy for Acute Ischemic Stroke are Explained by Confounding Factors

Milani Deb-Chatterji, Eckhard Schlemm, Fabian Flottmann, Lukas Meyer, Anna Alegiani, Caspar Brekenfeld, Jens Fiehler, Christian Gerloff, Götz Thomalla, GSR-ET Investigators, C Gerloff, J Fiehler, G Thomalla, A Alegiani, Boeckh-Behrens, Silke Wunderlich, Ulrike Ernemann, Sven Poli, Eberhard Siebert, Christian H Nolte, Sarah Zweynert, Georg Bohner, Alexander Ludolph, Karl-Heinz Henn, Waltraud Pfeilschifter, Fee Keil, Joachim Röther, Bernd Eckert, Jörg Berrouschot, Albrecht Bormann, László Solymosi, Gabor Petzold, Christoffer Kraemer, Martin Dichgans, Steffen Tiedt, Lars Kellert, Franziska Dorn, Martina Petersen, Florian Stögbauer, Michael Braun, Gerhard F Hamann, Klaus Gröschel, Timo Uphaus, Milani Deb-Chatterji, Eckhard Schlemm, Fabian Flottmann, Lukas Meyer, Anna Alegiani, Caspar Brekenfeld, Jens Fiehler, Christian Gerloff, Götz Thomalla, GSR-ET Investigators, C Gerloff, J Fiehler, G Thomalla, A Alegiani, Boeckh-Behrens, Silke Wunderlich, Ulrike Ernemann, Sven Poli, Eberhard Siebert, Christian H Nolte, Sarah Zweynert, Georg Bohner, Alexander Ludolph, Karl-Heinz Henn, Waltraud Pfeilschifter, Fee Keil, Joachim Röther, Bernd Eckert, Jörg Berrouschot, Albrecht Bormann, László Solymosi, Gabor Petzold, Christoffer Kraemer, Martin Dichgans, Steffen Tiedt, Lars Kellert, Franziska Dorn, Martina Petersen, Florian Stögbauer, Michael Braun, Gerhard F Hamann, Klaus Gröschel, Timo Uphaus

Abstract

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.

Keywords: Angiography; Gender difference; Intervention; Ischemia; Outcome predictors.

Conflict of interest statement

M. Deb-Chatterji, E. Schlemm, F. Flottmann, L. Meyer, C. Brekenfeld declare that they have no competing interests. A. Alegiani reports honoraria as speaker from Bayer Vital. J. Fiehler receives research support from the German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions- und Förderbank (IFB), Medtronic, Microvention, Philips, Stryker; and serves as a consultant for Acandis, Boehringer Ingelheim, Cerenovus, Evasc Neurovascular, MD Clinicals, Medtronic, Medina, Microvention, Penumbra, Route92, Stryker, Transverse Medical. C. Gerloff serves on scientific advisory boards for Bayer Vital, Boehringer Ingelheim, Acticor Biotech, Amgen, and Prediction Biosciences; has received funding for travel and/or speaker/consulting honoraria from Bayer Vital, Boehringer Ingelheim, Sanofi Aventis, Amgen, EBS Technologies, GlaxoSmithKline, Lundbeck, Pfizer, Silk Road Medical, and UCB, and Abbott; serves on editorial boards for INFO Neurologie & Psychiatrie and Aktuelle Neurologie and as editor of textbook Therapie und Verlauf neurologischer Erkrankungen; has received grants to supporting employees/scientists of his clinic from Merz Pharmaceuticals, Allergan, Novartis, and NeuroConn; and receives research support from Deutsche Forschungsgesellschaft, the European Union, Wegener Foundation, Schilling Foundation, and Werner-Otto-Foundation. G. Thomalla has received personal fees as consultant or lecturer from Acandis, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daichi Sankyo, Stryker, and research grants from Bayer, Federal Ministry for Economic Affairs and Energy (BMWi), Corona-Foundation, German Research Foundation (DFG), Else Kröner-Fresenius Foundation, European Union (Horizon 2020), German Innovation Fund.

© 2020. The Author(s).

Figures

Fig. 1
Fig. 1
Distribution of the mRS scores by sex at 90 days. The distribution of the mRS scores of women and men 90 days after stroke thrombectomy is displayed. mRS modified Rankin Scale
Fig. 2
Fig. 2
Predictors of outcome after stroke thrombectomy in clinical practice. Forest plot showing adjusted analyses (adjusted OR and 95% CI) of predictors of outcome after stroke thrombectomy in this patient cohort of clinical practice. Age, NIHSS, pre-stroke mRS, IVT, ASPECTS and successful reperfusion were significant predictors of independent outcome, while sex was not associated with outcome. aOR adjusted odds ratio, CI confidence interval, NIHSS National Institutes of Health Stroke Scale, mRS modified Rankin Scale, IVT intravenous thrombolysis, ASPECTS Alberta Stroke Program Early CT Score, mTICI modified thrombolysis in cerebral infarction score

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Source: PubMed

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