Impact of Sex Difference on Severity and Functional Outcome in Patients with Cardioembolic Stroke.
BACKGROUND
Female sex is a risk factor for thromboembolic events in Caucasian, but not in Japanese, patients with nonvalvular atrial fibrillation. However, it remains unclear whether the female sex is also a risk factor for severe stroke and unfavorable functional outcome in patients with cardioembolic (CE) stroke.


METHODS
Three hundred fifty-five consecutive patients with CE stroke within 48 hours after onset and with a modified Rankin Scale (mRS) score of 1 or lower before onset were studied. We compared basic characteristics, stroke severity, and functional outcome between female (n = 157) and male (n = 198) patients.


RESULTS
The mean age was higher in female than in male patients (80 ± 8 versus 75 ± 9 years, P < .00001). The congestive heart failure, hypertension, age [≥ 75 years], diabetes, stroke/transient ischemic attack [TIA] (CHADS2) score before onset was similar between the two groups (median, 3 [2-4] in both groups). Stroke severity on admission, assessed by the National Institutes of Health Stroke Scale (NIHSS), was higher in female than in male patients (13 [5-20] versus 8 [3-16], P = .0009). Functional outcome at discharge, assessed by mRS, was unfavorable in female than in male patients (3 [1-5] versus 2 [1-4], P = .005). An mRS score of 3 or higher at discharge was found more in female than in male patients (59% versus 39%, P = .0001). Multivariate analyses confirmed that female sex was a significant determinant of severe stroke (NIHSS ≥ 8) on admission (odds ratio [OR] to male = 1.97; 95% confidence interval [CI]; 1.24-3.15, P = .004) and for the mRS score of 3 or higher at discharge (OR = 1.83; 95% CI, 1.16-2.89; P = .01). Similar results were obtained by propensity-score matching analysis.


CONCLUSIONS
Female sex is a risk factor for severe stroke on admission and unfavorable functional outcome at discharge in Japanese patients with CE stroke.
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
Hirofumi
H
Tomita
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Joji
J
Hagii
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Norifumi
N
Metoki
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Shin
S
Saito
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Hiroshi
H
Shiroto
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Hiroyasu
H
Hitomi
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Takaatsu
T
Kamada
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Satoshi
S
Seino
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Koki
K
Takahashi
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Yoshiko
Y
Baba
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Satoko
S
Sasaki
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Takamitsu
T
Uchizawa
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Manabu
M
Iwata
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Shigeo
S
Matsumoto
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
Yoshihiro
Y
Shoji
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
Tomohiro
T
Tanno
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan; Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
Tomohiro
T
Osanai
Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
Minoru
M
Yasujima
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan; Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan. Electronic address: okumura@hirosaki-u.ac.jp.
Ken
K
Okumura
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D004185:Disability Evaluation; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D010351:Patient Discharge; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000925:Anticoagulants
Female sex; cardioembolic stroke; functional outcome; stroke severity