China National Clinical Research Center for Neurological Diseases, Beijing TianTan Hospital, Capital Medical University (M.W., C.-J.W., H.-Q.G., X.M., Y.J., X.Y., J.Z., Y.-Y.X., X.-Q.Z., L.-P.L., Y.J-.W., Z.-X.L.).
National Center for Healthcare Quality Management in Neurological Diseases (M.W., C.-J.W., H.-Q.G., X.Y., J.Z., Z.-X.L.).
Stroke. 2022 Jul;53(7):2268-2275. doi: 10.1161/STROKEAHA.121.037121. Epub 2022 Feb 8.
Sex differences in stroke outcomes are crucial to secondary prevention, but previous reports showed inconsistent results. We aimed to explore the sex differences in stroke outcomes in the Third China National Stroke Registry, a prospective multicenter registry study.
Among the 15 166 patients enrolled between 2015 and 2018, 9038 patients with acute ischemic stroke (AIS) were included. The primary outcomes were stroke recurrence, mortality, and unfavorable functional outcome (modified Rankin Scale > 2) at 3, 6, and 12 months. Cox regression model was used for stroke recurrence and mortality and logistic regression was used for the unfavorable functional outcome, and adjusted as follows: (1) Model 1: without adjustment; (2) Model 2: adjusted for potential risk factors, National Institutes of Health Stroke Scale at admission, prestroke modified Rankin Scale, tPA (tissue-type plasminogen activator) treatment, TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification, and onset-to-door time; (3) Model 3: adjusted for covariates from model 2 in addition to blood pressure and blood serum covariates. Multiple imputation was used for missing values, and sensitivity analyses were conducted to describe sex differences by age groups.
One-third (2802/9038) of the patients were women. Women were significantly older than men (64.78±10.84 versus 61.26±11.42, <0.001). In the fully adjusted model, female patients were more likely to have unfavorable functional outcomes at 3 months (odds ratio, 1.28 [1.09-1.50]), especially among patients aged 65 years or older (odds ratio, 1.39 [1.14-1.70]), but no difference was discovered in patients aged <65 years. There were no sex differences in stroke recurrence and mortality at 3, 6, or 12 months or unfavorable functional outcomes at 6 or 12 months after adjustment.
Compared with men, women with AIS were less likely to have favorable outcomes at 3 months in China, especially among those over 65 years of age. Experts should aim to tailor secondary prevention strategies for high-risk patients.
性别差异与卒中结局密切相关，对二级预防至关重要，但既往报告结果并不一致。我们旨在通过中国第三次国家卒中登记研究（一项前瞻性多中心登记研究），探讨卒中结局的性别差异。
在 2015 年至 2018 年期间纳入的 15166 例患者中，纳入 9038 例急性缺血性卒中（AIS）患者。主要结局为卒中复发、3、6 和 12 个月时的死亡率和不良功能结局（改良 Rankin 量表>2）。采用 Cox 回归模型评估卒中复发和死亡率，采用 logistic 回归评估不良功能结局，并进行如下调整：（1）模型 1：无调整；（2）模型 2：调整潜在危险因素、入院时美国国立卫生研究院卒中量表评分、卒前改良 Rankin 量表评分、tPA（组织型纤溶酶原激活物）治疗、TOAST（急性卒中治疗组织型纤溶酶原激活剂试验）分类和发病至入院时间；（3）模型 3：在模型 2 调整的基础上，进一步调整血压和血清学指标。对缺失值采用多重插补法进行处理，并进行敏感性分析，按年龄组描述性别差异。
1/3（2802/9038）的患者为女性。与男性相比，女性患者明显更年长（64.78±10.84 岁 vs. 61.26±11.42 岁，<0.001）。在完全调整模型中，女性患者在 3 个月时更易发生不良功能结局（优势比，1.28[1.09-1.50]），尤其是 65 岁及以上患者（优势比，1.39[1.14-1.70]），但 65 岁以下患者中未发现差异。在 3、6 和 12 个月时的卒中复发和死亡率，以及调整后的 6 个月和 12 个月时的不良功能结局方面，男女之间均无差异。
与男性相比，中国女性 AIS 患者在 3 个月时更易发生不良结局，尤其是 65 岁以上患者。专家应制定针对高危患者的二级预防策略。
Zotero 插件