Laurie Fraticelli1,2, Julie Freyssenge3,4,5, Clément Claustre3, Marielle Buisson6, Magali Bischoff3, Norbert Nighoghossian4,7, Laurent Derex4,7, Carlos El Khoury3,4,8. 1. RESCUe-RESUVal, Lucien Hussel Hospital, Vienne, France, l.fraticelli@resuval.fr. 2. EA4129, Systemic Health Pathway Laboratory, Lyon, France, l.fraticelli@resuval.fr. 3. RESCUe-RESUVal, Lucien Hussel Hospital, Vienne, France. 4. Univ. Lyon, University Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France. 5. UMR 5600 Environnement Ville Société CNRS, University Jean Moulin Lyon 3, Lyon, France. 6. Clinical Investigation Center, Hospices Civils de Lyon, Lyon, France. 7. Department of Stroke Medicine, Hospices Civils de Lyon, Lyon, France. 8. Emergency Department, Lucien Hussel Hospital, Vienne, France.
Abstract
BACKGROUND: Literature has highlighted sex-based differences in the natural course of stroke and in response to treatment with intravenous tissue plasminogen activator (tPA). OBJECTIVES: We aimed to compare the management and outcome of acute ischemic stroke (AIS) among women and men on a French registry based on a federated network of emergency physicians and neurologists. METHOD: We included 2,790 patients received tPA between 2010 and 2016 from the stroke centers in the RESUVal area. We provided age-adjusted analysis and multivariate models for determining the role of sex in the outcome measures. RESULTS: After age-adjustment, women presented more moderate to severe stroke at admission with more proximal occlusions. Among tPA eligible patients, the therapeutic strategy and in-hospital hemorrhagic complications were proportionally identical whatever the sex. The total ischemic time from onset symptom to thrombolysis did not differ from women to men. Age-adjusted 3-month mortality did not differ between women and men, and the determinants of mortality were age (relative risk [RR] 1.56 [1.37-1.78], p < 0.0001), proximal occlusion (RR 2.5 [1.88-3.33], p < 0.0001), and at least one complication (RR 2.43 [1.89-3.13], p < 0.0001). The determinants of poor functional outcome at 3 months were the sex (RR 1.22 [1.01-1.48] for women, p = 0.0385) and the occurrence of onset symptom in rural landscape (RR 1.26 [1.03-1.55], p = 0.0219) compared to urban landscape. CONCLUSIONS: We provided an exhaustive overview and real-life professional practices conditions in thrombolyzed AIS. Despite a later prehospital management in neurovascular units and more severe strokes at admission, women and men had both similar outcomes at hospital discharge and in 3-month survival, but women were associated to worst functional outcome at 3 months.
BACKGROUND: Literature has highlighted sex-based differences in the natural course of stroke and in response to treatment with intravenous tissue plasminogen activator (tPA). OBJECTIVES: We aimed to compare the management and outcome of acute ischemic stroke (AIS) among women and men on a French registry based on a federated network of emergency physicians and neurologists. METHOD: We included 2,790 patients received tPA between 2010 and 2016 from the stroke centers in the RESUVal area. We provided age-adjusted analysis and multivariate models for determining the role of sex in the outcome measures. RESULTS: After age-adjustment, women presented more moderate to severe stroke at admission with more proximal occlusions. Among tPA eligible patients, the therapeutic strategy and in-hospital hemorrhagic complications were proportionally identical whatever the sex. The total ischemic time from onset symptom to thrombolysis did not differ from women to men. Age-adjusted 3-month mortality did not differ between women and men, and the determinants of mortality were age (relative risk [RR] 1.56 [1.37-1.78], p < 0.0001), proximal occlusion (RR 2.5 [1.88-3.33], p < 0.0001), and at least one complication (RR 2.43 [1.89-3.13], p < 0.0001). The determinants of poor functional outcome at 3 months were the sex (RR 1.22 [1.01-1.48] for women, p = 0.0385) and the occurrence of onset symptom in rural landscape (RR 1.26 [1.03-1.55], p = 0.0219) compared to urban landscape. CONCLUSIONS: We provided an exhaustive overview and real-life professional practices conditions in thrombolyzed AIS. Despite a later prehospital management in neurovascular units and more severe strokes at admission, women and men had both similar outcomes at hospital discharge and in 3-month survival, but women were associated to worst functional outcome at 3 months.
Authors: Franck Mauvais-Jarvis; Noel Bairey Merz; Peter J Barnes; Roberta D Brinton; Juan-Jesus Carrero; Dawn L DeMeo; Geert J De Vries; C Neill Epperson; Ramaswamy Govindan; Sabra L Klein; Amedeo Lonardo; Pauline M Maki; Louise D McCullough; Vera Regitz-Zagrosek; Judith G Regensteiner; Joshua B Rubin; Kathryn Sandberg; Ayako Suzuki Journal: Lancet Date: 2020-08-22 Impact factor: 79.321
Authors: Luis Miguel Bello-Lujan; Jose Antonio Serrano-Sanchez; Juan Jose Gonzalez-Henriquez Journal: Int J Environ Res Public Health Date: 2022-07-31 Impact factor: 4.614