Abstract：
UNASSIGNED: Intravenous thrombolysis (IVT) is an approved treatment for patients with acute ischemic stroke irrespective of sex. However, the current literature on sex differences in functional outcomes following IVT is inconsistent. So far, a number of studies-including a previous analysis based on data from the Austrian Stroke Unit Registry (ASUR)-detected significant sex-related differences in functional outcome, while others did not report any differences between women and men. In addition, currently there is a lack of data on how sex-related differences evolve over time.
UNASSIGNED: To assess time trends of sex-related differences in functional outcome of ischemic stroke in a large nationwide cohort and to investigate associations of patient characteristics with functional outcome post thrombolysis in women and men. These data will offer crucial insights into whether sex differences in functional outcome persist despite the large advances in acute stroke treatment.
UNASSIGNED: We analyzed retrospective data of consecutive patients with acute ischemic stroke treated with IVT in 39 stroke centers contributing to the ASUR between 2006 and 2021. We included patients over 18 years of age diagnosed with an acute ischemic stroke who received IVT and with available data on functional outcome at 3 months after treatment. The primary outcome parameter was favorable functional outcome (modified Rankin Scale (mRS) of 0-2) at 3 months. Multivariable logistic regression analysis was performed in the overall population and stratified by sex to assess associations of baseline characteristics with functional outcome.
UNASSIGNED: Among 11,840 patients receiving IVT, 2489 of 5503 (45.4%) women achieved favorable functional outcome compared to 3787 of 6337 (59.8%) men. Overall, female sex was a statistically significant predictor of functional outcome after thrombolysis, but additional predictors of outcome differed between women and men. Female sex was independently associated with decreased chances of achieving functional independency (adjusted odds ratio (adjOR) = 0.87, 95% confidence interval (CI) = 0.79-0.96, p = 0.005) and we detected a statistically significant improvement in functional outcome over time only in men (year of treatment, adjOR (per year) = 1.04, 95% CI = 1.02-1.06, p < 0.001) but not in women (adjOR (per year) = 1.01, 95% CI = 0.99-1.03, p = 0.280). Hypertension, smoking, and longer or unknown onset-to-door times were statistically significant predictors of outcome only in male patients, whereas atrial fibrillation, prior myocardial infarction, and longer door-to-needle times were significantly associated with outcome only in women.
UNASSIGNED: Sex differences in functional outcome after IVT for acute ischemic stroke are persisting over the past years. Results of our analysis can increase awareness and a resulting focus on sex differences in predictors of outcome could be helpful in mitigating these differences in the future by supporting a more individualized patient care in clinical routine. Follow-up analyses are needed to assess this potential impact and its effect in the future.
UNASSIGNED: Data from the Austrian Stroke Unit Registry can only be accessed by the employed statistician (D.M.), access inquiries have to be addressed to the registry\'s academic review board.
UNASSIGNED: To assess time trends of sex-related differences in functional outcome of ischemic stroke in a large nationwide cohort and to investigate associations of patient characteristics with functional outcome post thrombolysis in women and men. These data will offer crucial insights into whether sex differences in functional outcome persist despite the large advances in acute stroke treatment.
UNASSIGNED: We analyzed retrospective data of consecutive patients with acute ischemic stroke treated with IVT in 39 stroke centers contributing to the ASUR between 2006 and 2021. We included patients over 18 years of age diagnosed with an acute ischemic stroke who received IVT and with available data on functional outcome at 3 months after treatment. The primary outcome parameter was favorable functional outcome (modified Rankin Scale (mRS) of 0-2) at 3 months. Multivariable logistic regression analysis was performed in the overall population and stratified by sex to assess associations of baseline characteristics with functional outcome.
UNASSIGNED: Among 11,840 patients receiving IVT, 2489 of 5503 (45.4%) women achieved favorable functional outcome compared to 3787 of 6337 (59.8%) men. Overall, female sex was a statistically significant predictor of functional outcome after thrombolysis, but additional predictors of outcome differed between women and men. Female sex was independently associated with decreased chances of achieving functional independency (adjusted odds ratio (adjOR) = 0.87, 95% confidence interval (CI) = 0.79-0.96, p = 0.005) and we detected a statistically significant improvement in functional outcome over time only in men (year of treatment, adjOR (per year) = 1.04, 95% CI = 1.02-1.06, p < 0.001) but not in women (adjOR (per year) = 1.01, 95% CI = 0.99-1.03, p = 0.280). Hypertension, smoking, and longer or unknown onset-to-door times were statistically significant predictors of outcome only in male patients, whereas atrial fibrillation, prior myocardial infarction, and longer door-to-needle times were significantly associated with outcome only in women.
UNASSIGNED: Sex differences in functional outcome after IVT for acute ischemic stroke are persisting over the past years. Results of our analysis can increase awareness and a resulting focus on sex differences in predictors of outcome could be helpful in mitigating these differences in the future by supporting a more individualized patient care in clinical routine. Follow-up analyses are needed to assess this potential impact and its effect in the future.
UNASSIGNED: Data from the Austrian Stroke Unit Registry can only be accessed by the employed statistician (D.M.), access inquiries have to be addressed to the registry\'s academic review board.
摘要：
背景：静脉溶栓（IVT）是一种经批准的急性缺血性卒中患者的治疗方法，不论性别。然而,目前关于IVT后功能结局性别差异的文献不一致.到目前为止,许多研究-包括先前基于奥地利卒中单位注册（ASUR）数据的分析-发现了功能结局的显着性别相关差异，而其他人则没有报告男女之间的任何差异。此外,目前缺乏有关性别差异如何随时间演变的数据。
目的：在全国大型队列中评估缺血性卒中功能结局性别差异的时间趋势，并调查女性和男性患者特征与溶栓后功能结局的关系。这些数据将提供至关重要的见解，以了解尽管急性中风治疗取得了重大进展，但功能结局的性别差异是否仍然存在。
方法：我们分析了在2006年至2021年期间39个卒中中心进行IVT治疗的连续急性缺血性卒中患者的回顾性资料。我们纳入了18岁以上被诊断为急性缺血性卒中的患者，这些患者接受了IVT，并在治疗后3个月获得了有关功能结局的可用数据。主要结果参数是3个月时的有利功能结果（0-2的改良Rankin量表（mRS））。在总体人群中进行多变量逻辑回归分析，并按性别分层，以评估基线特征与功能结局的关联。
结果：在11840例接受IVT的患者中，与3787/6337（59.8％）男性相比，2489/5503（45.4％）女性获得了良好的功能结局。总的来说,女性是溶栓后功能结局的统计学显著预测指标，但其他预测结果的因素在男女之间存在差异。女性性别与实现功能独立性的机会减少独立相关（adjOR0.87,95CI0.79-0.96，p=0.005），我们发现仅在男性中，随着时间的推移，功能结局有统计学上的显着改善（治疗年，adjOR（每年）1.04，95CI1.02-1.06，p<0.001），但不在女性中（adjOR（每年）1.01，95CI0.99-1.03，p=0.280）。高血压,吸烟,仅在男性患者中，更长或未知的发病时间是统计学上有意义的预后预测因子，而心房颤动,仅在女性患者中,既往心肌梗死和较长的进针时间与结局显著相关.
结论：急性缺血性卒中IVT后功能结局的性别差异在过去几年一直存在。我们的分析结果可以提高意识，并且通过在临床常规中支持更个性化的患者护理，对结果预测因子的性别差异的关注可能有助于减轻未来的这些差异。需要进行后续分析，以评估这种潜在影响及其在未来的影响。数据访问声明：来自奥地利中风单位登记处的数据只能由雇用的统计学家（DM）访问，访问查询必须提交给登记处的学术审查委员会。
目的：在全国大型队列中评估缺血性卒中功能结局性别差异的时间趋势，并调查女性和男性患者特征与溶栓后功能结局的关系。这些数据将提供至关重要的见解，以了解尽管急性中风治疗取得了重大进展，但功能结局的性别差异是否仍然存在。
方法：我们分析了在2006年至2021年期间39个卒中中心进行IVT治疗的连续急性缺血性卒中患者的回顾性资料。我们纳入了18岁以上被诊断为急性缺血性卒中的患者，这些患者接受了IVT，并在治疗后3个月获得了有关功能结局的可用数据。主要结果参数是3个月时的有利功能结果（0-2的改良Rankin量表（mRS））。在总体人群中进行多变量逻辑回归分析，并按性别分层，以评估基线特征与功能结局的关联。
结果：在11840例接受IVT的患者中，与3787/6337（59.8％）男性相比，2489/5503（45.4％）女性获得了良好的功能结局。总的来说,女性是溶栓后功能结局的统计学显著预测指标，但其他预测结果的因素在男女之间存在差异。女性性别与实现功能独立性的机会减少独立相关（adjOR0.87,95CI0.79-0.96，p=0.005），我们发现仅在男性中，随着时间的推移，功能结局有统计学上的显着改善（治疗年，adjOR（每年）1.04，95CI1.02-1.06，p<0.001），但不在女性中（adjOR（每年）1.01，95CI0.99-1.03，p=0.280）。高血压,吸烟,仅在男性患者中，更长或未知的发病时间是统计学上有意义的预后预测因子，而心房颤动,仅在女性患者中,既往心肌梗死和较长的进针时间与结局显著相关.
结论：急性缺血性卒中IVT后功能结局的性别差异在过去几年一直存在。我们的分析结果可以提高意识，并且通过在临床常规中支持更个性化的患者护理，对结果预测因子的性别差异的关注可能有助于减轻未来的这些差异。需要进行后续分析，以评估这种潜在影响及其在未来的影响。数据访问声明：来自奥地利中风单位登记处的数据只能由雇用的统计学家（DM）访问，访问查询必须提交给登记处的学术审查委员会。
