Introduction Sex differences in outcomes after acute ischemic stroke have been documented in the literature. However, few studies have assessed sex differences in outcomes after endovascular stroke thrombectomy of large vessel occlusion (LVO), and none have explored the relationship in a robust real-world registry.
Methods Data from the NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) registry was analyzed and compared for sex differences in stroke thrombectomy outcomes in 3261 patients from 23 US centers (17 states) between January 2015 to March 2020. Welch’s two-sided t-tests, Chi-square tests, and multivariate regression models were used to assess sex differences for 11 outcome variables: final thrombolysis in cerebral infarction (TICI) grade (n=3182), 24 hour NIH stroke score (NIHSS) (n=2842), post-procedure length of stay (n=3257), ICU days (n=2787), in-hospital mortality (n=3259), discharge status (n=3252), discharge NIHSS (n=2426), discharge modified Rankin score (mRS) (n=996), days to follow-up (n=1784), 90 day readmission rate (n=416), and 90 day mRS (n=1184). Models controlled for demographics, comorbidities, intravenous tPA thrombolysis, and pre-stroke functional measures.
Results Among the 3261 patients that underwent stroke thrombectomy, 49.4% were female (n=1622) and 50.6% were male (n=1639). T-tests and Chi-square tests revealed significant differences between females and males for post-procedure length of stay (8.1 versus 9.1; p=0.019), 24 hour NIHSS (11.1 versus 10.0; p=0.001), discharge status (30.8% home versus 34.5% home; p<0.001), days to follow-up (110 versus 126; p=0.008), and in-hospital mortality (25.3% versus 19.9%; p<0.001). There were no significant sex differences for discharge mRS without mortality (Female: 27.0% favorable outcome, Male: 26.7%; p=0.95) or for 90 day mRS without mortality (Female: 52.8% favorable outcome, Male: 49.5%; p=0.60). Multivariate regression models revealed that females had significantly higher 24 hour NIHSS (p=0.004), fewer days to follow-up (p=0.033), and higher rate of in-hospital mortality (p=0.036). The interaction term of African American x Male and Hispanic x Male were significant for post-procedure length of stay and ICU days, respectively (p=0.026 and p=0.022), indicating a differential effect of race on the outcome variable within males.
Conclusion Evidence from the NVQI-QOD registry suggests that there are differences between males and females in outcomes after acute stroke thrombectomy, with females showing consistently worse outcomes for short-term functional status, morbidity, and early mortality. Finally, there appears to be a differential effect of race on certain outcome variables within males.
Disclosures V. Thirunavu: None. R. Abdalla: None. D. Cantrell: None. M. Hurley: None. A. Shaibani: None. B. Jahromi: None. M. Potts: None. S. Ansari: None. O. NVQI-QOD Registry: None.
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