Long-Term Survival After Stroke According to Reperfusion Therapy, Cardiovascular Therapy and Gender

Jose Luis Clua-Espuny, Sonia Abilleira, Lluisa Queralt-Tomas, Antonia Gonzalez-Henares, Vicente Gil-Guillen, Eulalia Muria-Subirats, Juan Ballesta-Ors, Jose Luis Clua-Espuny, Sonia Abilleira, Lluisa Queralt-Tomas, Antonia Gonzalez-Henares, Vicente Gil-Guillen, Eulalia Muria-Subirats, Juan Ballesta-Ors

Abstract

Background: A wide variety of factors influence stroke prognosis, including age, stroke severity and comorbid conditions; but most current information about outcomes and safety is derived from patients at 3 - 12 months and mostly coming from the hospital activity. The aim of this study is to evaluate whether treatment strategies have a differential impact on long-survival after acute ischemic stroke among men versus women.

Methods: Acute ischemic stroke patients identified from the population-based register between January 1, 2011 and December 31, 2012 were included, and they were classified into: 1) Acute ischemic stroke + intravenous thrombolysis (group I); 2) Acute ischemic stroke + mechanical thrombectomy with or without intravenous thrombolysis (group II); 3) Acute ischemic stroke + medical therapy alone (no reperfusion therapies) (group III). Follow-up went through up until December 2016. The probability of survival was estimated by the Kaplan-Meier method, and the hazard ratio was obtained by using the Cox proportional hazard regression models. Mortality was interpreted as overall mortality.

Results: A total of 14,368 cases (men 50.1%), 77.1 ± 11.0 years old were included. There was higher survival among those treated with intravenous thrombolysis (P < 0.001); women treated with thrombectomy (P < 0.001); and women < 80 years old without reperfusion therapy. The most common medications were antiplatelets (52.8%), associated with lower survival (P < 0.001); and statins (46.5%), associated with higher survival. The regression model produced the following independent outcome variables associated to mortality: anticoagulant hazard ratio (HR) 1.53 (95% confidence interval (95% CI): 1.44 - 1.63, P < 0.001), diuretics HR 1.71 (95% CI: 1.63 - 1.79, P < 0.001), antiplatelet HR 1.49 (95% CI: 1.42 - 1.56, P < 0.001), statins HR 0.73 (95% CI: 0.70 - 0.77; P < 0.001), angiotensin II receptor antagonists HR 0.93 (95% CI: 0.89 - 0.98, P = 0.008) and reperfusion therapy HR 0.88 (95% CI: 0.81 - 0.97, P = 0.009).

Conclusions: Men and women have different prognoses after revascularization treatment for acute ischemic stroke. Under 80 years old the women appear to have a better outcome than men when treated with thrombolysis therapy and/or catheter-based thrombectomy. The chronic cardiovascular pharmacotherapy must be evaluated whether they should be included as factors in the decision to reperfusion.

Keywords: Acute ischemic stroke; Chronic comorbidities; Long-term survival; Revascularization therapy; Sex.

Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Overall mortality according to age (all cases).
Figure 2
Figure 2
Overall mortality according to revascularization procedure (all cases).
Figure 3
Figure 3
Survival probability for medical therapy including intravenous thrombolysis (group I) according to sex.
Figure 4
Figure 4
Survival curve for mechanical thrombectomy with or without intravenous thrombolysis (group II) according to sex.
Figure 5
Figure 5
Overall mortality according treatment group in men.
Figure 6
Figure 6
Overall mortality according treatment group in women.

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Source: PubMed

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