Background:
There are gender differences in the short-term prognosis following acute stroke suggesting that outcome is less favorable in women. Factors contributing to this poor outcome include preexisting morbidity, stroke severity and higher age. Most previous studies have looked at short-term prognosis. PURPOSE: We investigated whether gender differences have a differential impact on incidence of short-term outcome and long-term major adverse cardiovascular events (MACE) including stroke, myocardial infarction, unstable angina, coronary revascularization procedure, and death in patients with suspected acute stroke.
Methods:
The study used a prospective cohort of Qatari patients with suspected acute stroke between January 2014 and February 2019. We calculated the modified Rankin score (mRS) at discharge and 90-days (short-term) and MACE (long-term) outcomes in both genders. To determine the independent predictor for MACE, the Cox proportional hazards regression analysis was used and summarized as hazard ratio and 95% confidential interval.
Results:
A total of 1372 patients identified. At 90-days, women found to have significantly poorer outcome (34.0% vs 23.4%, p<0.001) mortality (8.5% vs 5.2%, p<0.03) overall. MACE was present in 30.5% (418/1372) during follow-up (57.2% males and 54.3% females, p=0.32). Median follow-up was 44.6 months for females and 47.2 months for males. Mean age in MACE group was significantly higher (65.5±15.3 vs 60.1±15.9, p< 0.001). Hypertension, diabetes, prior history of stroke, coronary artery disease, and atrial fibrillation on admission was more significant in MACE group, while obesity (BMI ≥ 30 kg/m2) was more common in non-MACE group. Patients with MACE had higher NIHSS on admission (6.1±7.4 vs 3.5±5.3, p<0.001), HbA1c (7.7±2.3 vs 7.4±2.3, p=0.02) and poorer prognosis (44.5% vs 18.6%, p<0.001) and higher mortality at 90-days. Once corrected, the hazard regression analysis showed that no difference in MACE between the two genders.
Conclusion:
Our results show that despite higher mortality and poor outcome at 90-days, the long-term outcome in women did not show any significant difference from men in this cohort. This may be related to older age and presence of cardiovascular risk factors.
Letter by Li et al Regarding Article, “NfL (Neurofilament Light Chain) Levels as a Predictive Marker for Long-Term Outcome After Ischemic Stroke”
