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Factors Mediating Outcome After Stroke: Gender, Thrombolysis, and Their Interaction

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Abstract

Several studies, but not all, have shown that women benefit more from intravenous thrombolysis than men; few have accounted for pre-stroke mobility. Our aim was to determine whether there was an interaction between gender and thrombolysis treatment in 3-month modified Rankin Scale (mRS) score, after adjusting for pre-stroke mobility. We retrospectively reviewed medical records of 1390 consecutive ischemic stroke patients admitted between October 2012 and July 2015. The 3-month mRS was obtained from clinic visits. Thrombolysis-by-gender interaction was evaluated in univariate and multivariate analyses using ordinal logistic (“shift”) regression with the full mRS range from 0 to 6 as the dependent variable. We included 926 (456 women and 470 men) patients with follow-up. Women were older (mean age 68.1 vs 65.8 years, P = 0.013), less likely to be treated with thrombolysis (15.6 vs 24.0%, P = 0.002), less often discharged to home (49.1 vs 59.6%, P = 0.001), and more likely to use ambulation aids pre-stroke (13.6 vs 8.5%, P = 0.014).Women had worse outcomes than men in those not treated with thrombolysis (mRS ≥ 3: 55.1 vs 40.1%, P < 0.001). In those who received thrombolysis, there were no gender differences (47.9 vs 50.4%, P = 0.736). In multivariable modeling, there was a significant gender-treatment interaction (P < 0.001), after adjustment for gender, pre-stroke ambulation aid use, age, age-by-gender interaction, initial stroke severity, diabetes, heart failure, and prior stroke. Our results show that women benefit from thrombolysis more than men, and the thrombolysis-by-gender interaction persists after adjustment for pre-stroke mobility impairment.

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Funding

This study was supported by the Department of Neurology at Wake Forest School of Medicine and the Soonchunhyang University Research Fund.

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Authors and Affiliations

  1. Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Gyeonggi, South Korea

    Seung-Jae Lee

  2. Department of Neurology, Kyung Hee University, College of Medicine, Seoul, South Korea

    Sung Hyuk Heo

  3. Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Walter T. Ambrosius

  4. Department of Neurology, One Medical Center Boulevard, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Cheryl D. Bushnell

Authors
  1. Seung-Jae Lee
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  2. Sung Hyuk Heo
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  3. Walter T. Ambrosius
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  4. Cheryl D. Bushnell
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Contributions

CB conceived and designed the study, and wrote the manuscript. SJL participated in its design, the acquisition of data, and the writing of manuscript. He also created all figures. SHH participated in the acquisition of data. WTA performed the statistical analysis and aided in the final edits to the manuscript. All authors contributed to data analysis and interpretation, and the final drafts of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cheryl D. Bushnell.

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Competing Interests

The authors declare that they have no competing interests.

Ethics Approval

This study was approved with waiver of informed consent by the Wake Forest University Health Sciences Institutional Review Board.

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Lee, SJ., Heo, S.H., Ambrosius, W.T. et al. Factors Mediating Outcome After Stroke: Gender, Thrombolysis, and Their Interaction. Transl. Stroke Res. 9, 267–273 (2018). https://doi.org/10.1007/s12975-017-0579-6

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  • DOI: https://doi.org/10.1007/s12975-017-0579-6

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