Long-term mortality and thrombolysis therapy after a first acute ischemic stroke: gender

differences. Ebrictus II Study. Authors & Affiliations Clua-Espuny JL1; González-Henares MªA2; López-

Pablo, C3; Queralt-Tomas Mª Ll4; Ripolles-Vicente R1; Panisello-Tafalla A2; Lucas-Noll J5; Calduch-Noll C6 on Behalf of Ebrictus Group Investigators1.

1. Primary Care. Institut Català Salut. EAP Tortosa 1-est. Spain. 2. Primary Care. Institut Català Salut. EAP Aldea-Camarles-Ampolla. Spain. 3. USR Terres de l’Ebre, IDIAP Jordi Gol-IISPV-Fundació Dr. Ferran, Spain 4. Primary Care.

Institut Català Salut. EAP Tortosa est. Spain. 5. Primary Care. Institut Català Salut. EAP Deltebre. Spain. 6. Primary Care. Institut Català Salut. UUDD Tortosa. Spain.

The territory is placed ar the Catlonia South in the north-east of Spain.

:

1 Tortosa 1 est, 2 Tortosa 2 oest, 3 Ulldecona-la Sènia, 4 Ametlla de Mar-Perelló, 5 Aldea-Ampolla-Camarles, 6 Deltebre, 7 Amposta, 8 St Carles de la Ràpita-Alcanar;

y centros hospitalarios del territorio.

1

12

3

45

67

8

Hospital referencia código Ictus

ALT PIRINEU-ARANGI RONA

LLEIDACENTRAL

BARCELONA

TARRAGONA

TERRES DE L'EBRE

Garrigues

Alt Empordà

BaixEmpordà

Maresme

VallèsOriental

VallèsOccidental

BarcelonèsBaixLlobregat

Cerdanya

Solsonès

Bages

Berguedà

Ripollès

Osona

Selva

Pla del’Estany

Garrotxa

Garraf

SegriàConca

de Barberà

Segarra

Noguera

Priorat

PallarsSobirà

PallarsJ ussà

Gironès

Alt Penedès

Anoia

TarragonèsBaix

Camp

Urgell

Alt Urgell

AltCamp

Baix Ebre

AltaRibagorça

BaixPenedès

Montsià

Riberad’Ebre

TerraAlta

Plad’Urgell

Val d’Aran

LlegendaCentres amb Codi Ictus Implementats

prèviament al Pla Director.

Centres amb Codi Ictus Implementats i impulsats pel Pla Director.

2006

Centres de referència Codi Ictus, Catalunya 2006

“Pla Director de les Malalties de l’Aparell Circulatori”

Rationale A number of large trials have confirmed the benefits of thrombolysis in acute stroke, but there are gender differences in stroke.Methods & ResultsEbrictus Project is a study based on a cohort population from incident cases on the first stroke episode (included TIA) from 01/04/2006 to 31/12/2013 participated by Primary care and neurological service referent. Statistical approaches for analyzing survival outcomes and their relation with thrombolysis therapy.A total of 1337 first-ever strokes were included (614 in women). Mean age 74.06±11.9 years (25-90), higher percentage (p 0.004) women than men (54.1%), and significant differences (p <0.001) in the mean age men (72.34±11.9) and females (76.09±11.7) and significantly older (p <0.001) than those in the thrombolysis (68.8±12.0).

The mean follow-up was 3.12±2.51 years. The average disease duration is 6.67 years. At 90 days was similar in men and women produced 34.8% of deaths and at five years an 44.9%(ICI95% 42.2-47.6). No differences in adjusted mortality rates between sexes (Fig. 1). The incidence rate ratio by sex is 1.003 (IC95% 0.86-1.17). Cumulative probability of overall survival is 0.92±0.08 the first month, 0.77±0.01 in the first year and 0.52±0.01 at five years.

The mortality curves among the ischemic with or withoutthrombolysis are significantly (p <0.003) different (Fig. 2). The Incidence Ratio is 0.57 (CI95% 0.39-0.83). The reduc-tion RRR is 39.8% and ARR 18%, and the NNT 5 to prevent one death. Were identified as protective factorsof mortality: the realization of thrombolysis (CI95% 0.37-0.80 p 0.002), and Barthel ≥ 60 (CI95% 0.81- 0.94 p 0.002) score.

98 (8.6%) patients (48 in women) received thrombolysis. The difference in the number of deaths by gender increases so that at end of period survival is significantly lower in women (Fig. 3). The probability of survival at end of study among women was 0.75±0.06 and 0.54±0.09 men, a statistically significant difference (p 0.012) and showed an increased risk in men compared to women IR = 3.2 (IC95% 1.2-8.0), we can indicate that exposure to thrombolysis in women is much more protective than men.

Conclusion stroke death rates were lower in women after thrombolysis treatment and suggest significant benefit for women in this setting.Clinical RelevanceIt still remains to be determined whether is true gender difference in response to thrombolysis treatment. The challenge is whether these data can achieve better health outcomes through the selection of patients with a more favorable risk versus thrombolytic profile. Key words: Stroke. Thrombolysis. Community based study. Mortality. Survival.

SURVIVAL-ALL

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