Genderaspekte des ischämischen Schlaganfalls Analyse des österreichischen Stroke-Unit Registers

Abstract

Available studies suggest gender-related differences in the management of stroke patients. We therefore aimed to address this issue in a large cohort of ischemic stroke patients admitted to Stroke-Units in Austria. The database contained information on 15746 prospectively documented cases for descriptive statistical analysis. A total of 13831 (6670 women) were classified as ischemic stroke. Concerning risk factors and stroke aetiology female stroke patients were more likely to have a history of atrial fibrillation (31.1% vs. 20.8%, p<0.001) and suffered more often from cardioembolic strokes (19.9% vs. 15.5%) than males. Women were significantly older than men (mean age in years: 73.4+/-13.8 vs. 67.8+/-12.7, p<0.001), had a more severe neurologic deficit at admission (NIH-SS: 7.7 vs. 6.0, Barthel-Index: 52.2 vs. 62.3, p<0.001) and at discharge (NIH-SS: 5.3 vs. 4.2, Barthel-Index: 65.0 vs. 73.9, p<0.001) and were more severely handicapped at 3-month follow-up (Rankin-Score: 2.1 vs. 1.6, p<0.001). However, when comparing age decades statistically significant differences concerning the higher neurological deficit and dependency in women were present only in patient groups over 70 years. Furthermore, women showed a significantly higher in-Stroke-Unit complication rate (20.2% vs. 16.5%, p<0.001) and risk of death (3.5% vs. 2.4%, p<0.001). The 3-month mortality rate was also higher in women (10.9% vs. 7.7%, p<0.001). Concerning stroke management, we did not find a disadvantage of women vs. men regarding the delay between stroke onset and hospital admission (median: 120 vs. 124 min), delay and frequency of first cerebral imaging, frequency of thrombolysis (7.4% vs. 7.8%, n.s.) and of secondary prevention with antiplatelet therapies (76.4% vs. 76.2%, n.s.). Despite their higher prevalence of atrial fibrillation, female patients were not put on oral anticoagulation more often than men (19.4% vs. 20.6%, at 3 months, n.s.). This analysis of a large patient population did not show gender disparities in the quality of management of stroke patients treated in Austrian Stroke-Units. However, women had a worse outcome after stroke, which appears to be related primarily to greater deficits at onset in combination with higher age and associated factors. We also confirmed the prominent role of cardiac disorders especially for female stroke patients.