Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Denmark (J.M., G.A.).
Department of Clinical Medicine, Aarhus University, Denmark (J.M., G.A.).
Stroke. 2020 Aug;51(8):2332-2338. doi: 10.1161/STROKEAHA.119.028589. Epub 2020 Jul 9.
Previous studies from local settings have reported that women with acute ischemic stroke have a lower chance of receiving reperfusion therapy treatment, including intravenous thrombolysis and thrombectomy, than men, but the underlying mechanisms of this disparity have not been identified. We aimed to examine sex differences in the utilization of reperfusion therapy focusing on all the phases of pre- and in-hospital time delay in a nationwide population-based cohort.
This study was based on data from nationwide public registries. The study population included patients aged at least 18 years admitted with acute ischemic stroke using emergency medical services in Denmark dispatched after an emergency call in the period 2016 to 2017. Study outcomes included time delays from symptom onset to start of reperfusion therapy and use of reperfusion therapy. Data were analyzed using multivariable quantile regression and logistic regression.
A total of 5356 stroke events fulfilled the inclusion criteria. Women (26.6%) were less likely to receive intravenous thrombolysis than men (30.2 %), corresponding to an unadjusted odds ratio of 0.84 (95% CI, 0.74-0.95). In addition, women experienced a 20 minutes longer median time delay from stroke symptom onset to stroke unit arrival than men. Adjusting for onset-to-door time only appeared to have a limited effect on the sex differences in use of intravenous thrombolysis, whereas the odds ratio was 1.06 (95% CI, 0.93-1.21) when adjusting for age at stroke, stroke severity, and cohabitation status. No sex difference was observed for the use of thrombectomy.
Women received less reperfusion therapy than men and had a longer time delay from symptom onset to stroke unit arrival, primarily due to a longer delay from symptom onset to emergency medical services call. These differences appeared to be due to the higher age and the higher proportion of women living alone at the time of the stroke.
来自当地环境的先前研究报告称，女性急性缺血性脑卒中患者接受再灌注治疗（包括静脉溶栓和血栓切除术）的机会低于男性，但尚未确定这种差异的潜在机制。我们旨在通过全国基于人群的队列研究，在发病前和住院期间的所有阶段检查再灌注治疗利用方面的性别差异。
本研究基于全国公共登记处的数据。研究人群包括 2016 年至 2017 年期间丹麦使用紧急医疗服务因紧急呼叫而入院的至少 18 岁急性缺血性脑卒中患者。研究结果包括从症状发作到开始再灌注治疗的时间延迟和再灌注治疗的使用。使用多变量分位数回归和逻辑回归分析数据。
共有 5356 例卒中事件符合纳入标准。女性（26.6%）接受静脉溶栓治疗的可能性低于男性（30.2%），未调整的优势比为 0.84（95%可信区间，0.74-0.95）。此外，女性从卒中症状发作到卒中单元到达的中位时间延迟比男性长 20 分钟。仅调整发病至入院时间似乎对静脉溶栓治疗的性别差异影响有限，而调整年龄、卒中严重程度和同居状况后，优势比为 1.06（95%可信区间，0.93-1.21）。血栓切除术的使用未观察到性别差异。
女性接受的再灌注治疗少于男性，从症状发作到卒中单元到达的时间延迟更长，主要是因为从症状发作到紧急医疗服务呼叫的时间延长。这些差异似乎归因于女性年龄较高，以及卒中时独居的女性比例较高。
