Sex-Based Analysis of Workflow and Outcomes in Acute Ischemic Stroke Patients Treated With Alteplase Versus Tenecteplase.

Autor:	Kim DJ; Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada., Singh N; Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., J.S.)., Catanese L; Hamilton Health Sciences Centre, McMaster University, Hamilton, ON, Canada (L.C.)., Yu AYX; Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada., Demchuk AM; Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada.; Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada.; Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada., Lloret-Villas MI; Division of Neurology, University of Alberta, Edmonton, Canada (M.I.L.-V.)., Deschaintre Y; Department of Neurosciences, Université de Montréal, QC, Canada (Y.D.)., Coutts SB; Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada.; Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada.; Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada., Khosravani H; Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada., Appireddy R; Division of Neurology, Queen's University, Kingston, ON, Canada (R.A.)., Moreau F; Université de Sherbrooke, QC, Canada (F.M.)., Gubitz G; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (G.G., S.P.)., Tkach A; Kelowna General Hospital, BC, Canada (A.T.)., Dowlatshahi D; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)., Medvedev G; Royal Columbian Hospital, New Westminster, BC, Canada (G.M.)., Mandzia J; London Health Sciences Centre, Western University, London, ON, Canada (J.M.)., Pikula A; Toronto Western Hospital (A.P.), University of Toronto, ON, Canada., Shankar J; Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., J.S.)., Williams H; Queen Elizabeth Hospital, Charlottetown, PE, Canada (H.W.)., Manosalva H; Medicine Hat Regional Hospital, AB, Canada (H.M.)., Siddiqui M; Grey Nuns Community Hospital, Edmonton, AB, Canada (M.S.)., Zafar A; St Michael's Hospital, Toronto, ON, Canada (A.Z.)., Imoukhuede O; Red Deer Regional Hospital, AB, Canada (O.I.)., Hunter G; University of Saskatchewan, Saskatoon, Canada (G.H.)., Phillips S; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (G.G., S.P.)., Hill MD; Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada.; Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada.; Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada., Poppe AY; Centre Hospitalier de l'Université de Montréal, QC, Canada (A.Y.P.)., Ademola A; Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada.; Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada., Shamy M; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)., Bala F; Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada., Sajobi TT; Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada.; Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada., Swartz RH; Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada., Almekhlafi MA; Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada.; Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada.; Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada., Menon BK; Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada.; Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada.; Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada., Field TS; Vancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, Canada (T.S.F.).
Jazyk:	angličtina
Zdroj:	Stroke [Stroke] 2024 Feb; Vol. 55 (2), pp. 288-295. Date of Electronic Publication: 2024 Jan 04.
DOI:	10.1161/STROKEAHA.123.045320
Abstrakt:	Background: Understanding sex differences in stroke care is important in reducing potential disparities. Our objective was to explore sex differences in workflow efficiency, treatment efficacy, and safety in the AcT trial (Alteplase Compared to Tenecteplase). Methods: AcT was a multicenter, registry-linked randomized noninferiority trial comparing tenecteplase (0.25 mg/kg) with alteplase (0.9 mg/kg) in acute ischemic stroke within 4.5 hours of onset. In this post hoc analysis, baseline characteristics, workflow times, successful reperfusion (extended Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracerebral hemorrhage, 90-day functional independence (modified Rankin Scale score, 0-1), and 90-day mortality were compared by sex. Mixed-effects regression analysis was used adjusting for age, stroke severity, and occlusion site for outcomes. Results: Of 1577 patients treated with intravenous thrombolysis (2019-2022), 755 (47.9%) were women. Women were older (median, 77 [68-86] years in women versus 70 [59-79] years in men) and had a higher proportion of severe strokes (National Institutes of Health Stroke Scale score >15; 32.4% versus 24.9%) and large vessel occlusions (28.7% versus 21.5%) compared with men. All workflow times were comparable between sexes. Women were less likely to achieve functional independence (31.7% versus 39.8%; unadjusted relative risk, 0.80 [95% CI, 0.70-0.91]) and had higher mortality (17.7% versus 13.3%; unadjusted relative risk, 1.33 [95% CI, 1.06-1.69]). Adjusted analysis showed no difference in outcomes between sexes. Conclusions: Differences in prognostic factors of age, stroke severity, and occlusion site largely accounted for higher functional dependence and mortality in women. No sex disparities were apparent in workflow quality indicators. Given the integration of the AcT trial into clinical practice, these results provide reassurance that no major sex biases are apparent in acute stroke management throughout participating Canadian centers. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249. Competing Interests: Disclosures Dr Field reports compensation from AstraZeneca, Bayer, BMS-Pfizer, HLS Therapeutics, and Roche for consultant services, the Canadian Medical Protective Association as an expert witness, a grant from Bayer, and is on the board of DESTINE Health. Dr Menon reports stock options in Circle CVI and has consulted for Hoffman-Laroche and Boehringer Ingelheim. Dr Coutts is a principal investigator for the TEMPO-2 trial (A Randomized Controlled Trial of TNK-tPA Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion) with the study drug (tenecteplase) provided by Boehringer Ingelheim. Dr Hill reports compensation from BrainsGate for consultant services, grants from Boehringer Ingelheim, the Canadian Institutes of Health Research, Medtronic, MicroVention, Inc, and NoNo, Inc, end point review committee work for Merck, and employment as a professor with the University of Calgary. Dr Poppe reports grants from Stryker, Fondation Brain Canada, and the Heart and Stroke Foundation of Canada. Dr Demchuk reports compensation from Boehringer Ingelheim, HLS Therapeutics, Hoffman-Laroche, Medtronic, NovaSignal, and Servier for consultant services, others from AstraZeneca, Novo Nordisk, and Pfizer, data safety monitoring board participation with Philips, and stock and patent for stroke imaging software with Circle NVI. Dr Catanese reports compensation from Hoffman-Laroche for consultant fees and a grant from Servier. Dr Yu reports grants from the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada. Dr Deschaintre reports other compensation from the Association des neurologues du Québec, the Société des Sciences Vasculaires du Québec, and the Université du Montréal. Dr Siddiqui reports a grant from Allergan and other compensation from Bayer and Boehringer Ingelheim. Dr Swartz reports grants from the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, the National Institutes of Health, and the Sunnybrook Research Institute and stock in FollowMD, Inc. The other authors report no conflicts.
Databáze:	MEDLINE
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