背景:2015年,大血管闭塞的血管内治疗(EVT)成为急性缺血性卒中的标准治疗。据报道,女性使用静脉注射阿替普酶的比例较低,但在美国EVT使用中是否存在性别差异尚未确定。
方法:我们确定了2012年至2019年期间所有符合EVT标准的急性缺血性卒中出院患者。根据美国国立卫生研究院卒中量表评分≥6且到达<6小时,根据2018年美国心脏协会/ASA指南。多变量回归分析用于确定性别和EVT利用之间的关系,和结果(包括死亡率,出院回家,功能状态)在EVT后。对两个时间段分别进行了分析:2012年至2014年和2015年至2019年。
结果:在302965名可能符合EVT条件的患者中,42422(14%)接受EVT。2015年之前,女性EVT治疗率为5.3%,男性为6.6%。从2015年到2019年,男女的治疗率上升到女性的16.7%和男性的18.5%。与男性相比,女性EVT的调整比值比在2015年之前为0.93(95%CI,0.87-0.99),在2015年之后为0.98(95%CI,0.96-1.01)。结果没有显著的性别差异,除了2015年之后,女性出院时的步行能力降低(调整后的优势比,0.95[95%CI,0.95-0.99]),住院死亡率较低(调整后比值比,0.93[95%CI,0.88-0.99])。
结论:自2015年EVT批准以来,女性和男性的EVT利用率均大幅增加。经过统计调整后,女性最初接受EVT的可能性较小,但在2015年之后,女性接受EVT的可能性与男性相同。EVT后,与男性相比,女性出院时残疾的可能性更大,但住院死亡的可能性更小.
BACKGROUND: In 2015, endovascular therapy (EVT) for large vessel occlusions became standard of care for acute ischemic stroke. Lower utilization of IV alteplase has been reported in women, but whether sex differences in EVT use in the United States exists has not been established.
METHODS: We identified all acute ischemic stroke discharges from Get With The
Guidelines-Stroke hospitals between 2012 and 2019 who were potentially eligible for EVT, based on National Institutes of Health Stroke Scale score ≥6 and arrival <6 hours, according to 2018 American Heart Association/ASA
guidelines. Multivariable regression analyses were used to determine the association between sex and EVT utilization, and outcomes (including mortality, discharge home, functional status) after EVT. Separate analyses were conducted for the 2 time periods: 2012 to 2014, and 2015 to 2019.
RESULTS: Of 302 965 patients potentially eligible for EVT, 42 422 (14%) received EVT. Before 2015, EVT treatment rates were 5.3% in women and 6.6% in men. From 2015 to 2019, treatment rates increased in both sexes to 16.7% in women and 18.5% in men. The adjusted odds ratio for EVT in women compared with men was 0.93 (95% CI, 0.87-0.99) before 2015, and 0.98 (95% CI, 0.96-1.01) after 2015. There were no significant sex differences in outcomes except that after 2015, women were less able to ambulate at discharge (adjusted odds ratio, 0.95 [95% CI, 0.95-0.99]) and had lower in-hospital mortality (adjusted odds ratio, 0.93 [95% CI, 0.88-0.99]).
CONCLUSIONS: EVT utilization has increased dramatically in both women and men since EVT approval in 2015. Following statistical adjustment, women were less likely to receive EVT initially, but after 2015, women were as likely as men to receive EVT. After EVT, women were more likely to be disabled at discharge but less likely to experience in-hospital death compared with men.