Analysis of tissue plasminogen activator eligibility by sex in the Greater Cincinnati/Northern Kentucky Stroke Study.
Analysis of tissue plasminogen activator eligibility by sex in the Greater Cincinnati/Northern Kentucky Stroke Study.
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DOI：
10.1161/strokeaha.114.006737
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发表时间：
2015-03
期刊：
影响因子：
8.3
通讯作者：
Kleindorfer D
中科院分区：
文献类型：
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作者：
Madsen TE;Khoury JC;Alwell KA;Moomaw CJ;Kissela BM;De Los Rios La Rosa F;Woo D;Adeoye O;Flaherty ML;Khatri P;Ferioli S;Kleindorfer D
重组组织型纤溶酶原激活剂（r-tPA）的使用在一些人群中存在性别差异。目前尚不清楚这是由于资格差异还是由于严重高血压的可修改排除标准。我们的目的是调查在r-tPA适格性、个体排除标准和可修改的排除标准高血压中的性别差异。我们纳入了2005年到16个地区急诊科就诊的大辛辛那提/北肯塔基地区居民中所有≥18岁的缺血性卒中患者。采用2013年美国心脏协会（AHA）和欧洲急性卒中合作研究（ECASS） III指南确定r-tPA治疗资格和个体排除标准。1837例缺血性中风中，58%为女性，24%为黑人。女性的平均年龄为72.2岁，男性为66.1岁。即使在调整了年龄（7.0%和5.9%，P=0.32）后，r-tPA的适格性在性别上也是相似的（男性6.8%，女性6.1%，P=0.55）。超过3小时和4.5小时到达的女性和男性比例相似，但更多的女性患有严重的高血压。重度高血压患者的血压治疗率无性别差异（女性14.6%，男性20.8%；P=0.21）。更多的女性年龄在80岁至80岁之间，并且患有美国国立卫生研究院卒中量表（NIHSS）。在大量的混血儿人群中，r-tPA的适格性在性别上是相似的。女性更有可能有严重高血压的可修改排除标准，但不太可能接受治疗。女性更有可能符合5项ECASS III排除标准中的2项。女性高血压治疗不足是报告中r-tPA给药差异的潜在可改变因素。
Sex differences in recombinant tissue-type plasminogen activator (r-tPA) administration are present in some populations. It is unknown whether this is because of eligibility differences or the modifiable exclusion criterion of severe hypertension. Our aim was to investigate sex differences in r-tPA eligibility, in individual exclusion criteria, and in the modifiable exclusion criterion, hypertension. We included all ischemic stroke patients ≥18 years among residents of the Greater Cincinnati/Northern Kentucky region who presented to 16-area emergency departments in 2005. Eligibility for r-tPA and individual exclusion criteria were determined using 2013 American Heart Association (AHA) and European Cooperative Acute Stroke Study (ECASS) III guidelines. Of 1837 ischemic strokes, 58% were women, 24% were black. Mean age in years was 72.2 for women and 66.1 for men. Eligibility for r-tPA was similar by sex (6.8% men and 6.1% women; P=0.55), even after adjusting for age (7.0% and 5.9%; P=0.32). Similar proportions of women and men arrived beyond 3- and 4.5-hour time windows, but more women had severe hypertension. There were no sex differences in blood pressure treatment rates among those with severe hypertension (14.6% women and 20.8% men; P=0.21). More women were >80 years and had National Institutes of Health Stroke Scale (NIHSS) >25. Within a large, biracial population, eligibility for r-tPA was similar by sex. Women were more likely to have the modifiable exclusion criterion of severe hypertension but were not more likely to be treated. Women were more likely to have 2 of the 5 ECASS III exclusion criteria. Undertreatment of hypertension in women is a potentially modifiable contributor to reported differences in r-tPA administration.