Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females

Objective: It has been reported that the mortality due to ischemic stroke is higher and the prognosis is worse in women compared with men. The aim of this study was to determine the etiologic subtypes, risk factors, and prognosis of acute ischemic stroke (AIS) in females. Materials and Methods: We reviewed the medical records of 957 patients who were admitted with AIS between January 2011 and May 2017. The patients’ records were analyzed and the demographic data, risk factors, National Institutes of Health Stroke Scale (NIHSS) scores at admission, and modified Rankin Scale (mRS) in the follow-up were recorded. We determined etiologic stroke subtypes using the Automated Causative Classification System. Results: In the study, 432 (45.1%) female patients [mean age: 71.2±14.7 (range: 21-100) years] and 525 (54.9%) male patients [mean age: 67.2±12.9 (range: 25-103) years] were included. The women were older than the men (p<0.001). Atrial fibrillation (AF) and congestive heart failure were more common in females (p<0.001). Otherwise, coronary artery disease was more common in males (p<0.001). NIHSS score at admission and the number of patients with mRS scores over 2 in the follow-up after discharge were higher in female patients than in male patients (p<0.05). The most common ischemic stroke etiology in females was cardioembolism (48.4%), whereas it was in major large artery atherosclerosis in males (31.6%). On logistic regression analysis, AF and cardio-aortic embolism were significantly associated with female sex (p<0.05). Conclusion: In our series, AIS was more severe and caused more disability in females compared with males. AF was more common as an underlying etiology of ischemic stroke in females. These results reveal the importance of AF screening and anticoagulant treatment prophylaxis in the older female population.

Anahtar Kelime:

Kadınlarda Akut İskemik İnmenin Etiyolojik Alt Tipleri, Risk Faktörleri ve Erken Dönem Prognozu

Öz:

Amaç: Kadınlarda erkeklere göre iskemik inmeye bağlı mortalitenin daha yüksek ve prognozun daha kötü olduğu bildirilmiştir. Bu çalışmanın amacı kadınlarda akut iskemik inmenin (Aİİ) etiyolojik alt tiplerini, risk faktörlerini ve erken dönem prognozunu belirlemektir. Gereç ve Yöntem: Ocak 2011 ve Mayıs 2017 arasında Aİİ nedeniyle hastanemize başvuran 957 hasta çalışmaya alınmıştır. Hastaların kayıtları incelenerek demografik verileri, risk faktörleri, başvuru Ulusal Sağlık İnme Enstitü Ölçeği (NIHSS) skorları ve taburculuk sonrası modifiye Rankin Skalası (mRS) skorları ile klinik seyirleri kaydedilmiştir. İnme subtipleri otomatize “The Automated Causative Classification System” kullanılarak tespit edilmiştir. Bulgular: Hastaların 432’si kadın (%45,1), 525’i erkekti (%54,9). Kadın hastaların ortalama yaşı 71,2±14,7 iken, erkek hastalarınki 67,2±12,9 olarak saptandı. Aİİ ile başvuran kadın hastaların erkeklere göre daha ileri yaşta olduğu görüldü (p<0,001). Atriyal fibrilasyon (AF) ve konjestif kalp yetmezliğinin kadınlarda daha fazla olduğu saptandı (p<0,001). Öte yandan koroner arter hastalığı erkeklerde daha fazla idi (p=0,001). Ortalama NIHSS skoru kadınlarda anlamlı olarak daha yüksekti (p<0,001). Rekürren inme ve hastanedeki mortalite oranları açısından fark saptanmazken, taburculuk sonrası mRS 2 veya üzerinde olan hastaların sayısının, kadın grubunda anlamlı olarak daha yüksek olduğu görüldü (p=0,021). Kadınlarda en sık görülen iskemik inme etiyolojisi kardiyoembolizm (%48,4) iken, erkeklerde büyük arter aterosklerozuydu (%31,6). Çoklu regresyon analizi yapıldığında Aİİ’li hastalarda kadın cinsiyet ile AF ve kardiyo-aortik embolizm arasında anlamlı ilişkili bulunmuştur (p<0,05). Sonuç: Bizim serimizde kadınlarda Aİİ’nin daha şiddetli geliştiği ve daha fazla özürlülük yarattığı tespit edilmiştir. Kadın hastalarımızda öncelikli altta yatan inme nedeninin AF olduğu görülmüştür. Bu veriler; ileri yaş kadın popülasyonda AF taramalarının ve antikoagülan tedavi profilaksisinin önemini ortaya koymaktadır

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Arnao V, Acciarresi M, Cittadini E, Caso V. Stroke incidence, prevalence and mortality in women worldwide. Int J Stroke 2016;11:287-301.
2. Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation 2019;139:e56-e528.
3. Seshadri S, Beiser AS, Kelly-Hayes M, et al. The lifetime risk of stroke. Estimates from the Framingham Study. Stroke 2006;37:345-350.
4. GBD 2016 Lifetime Risk of Stroke Collaborators, Feigin VL, Nguyen G, et al. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. N Engl J Med 2018;379:2429-2437.
5. Ullberg T, Zia E, Petersson J, Norrving B. Changes in functional outcome over the first year after stroke: an observational study from the Swedish stroke register. Stroke 2015;46:389-394.
6. Peters SA, Huxley RR, Woodward M. Comparison of the sex-specific associations between systolic blood pressure and the risk of cardiovascular disease: a systematic review and meta-analysis of 124 cohort studies, including 1.2 million individuals. Stroke 2013;44:2394-2401.
7. Emdin CA, Wong CX, Hsiao AJ, et al. Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies. BMJ 2016;532:h7013.
8. Nezu T, Hosomi N, Kondo K, et al. Greater severity of neurological defects in women admitted with atrial fibrillation-related stroke. Circ J 2016;80:250-255.
9. Lisabeth LD, Reeves MJ, Baek J, et al. Factors influencing sex differences in poststroke functional outcome. Stroke 2015;46:860-863.
10. Christensen H, Bushnell C. Stroke in women. Continuum (Minneap Minn) 2020;26:363-385.
11. Franconi F, Campesi I, Occhioni S, Tonolo G. Sex-gender differences in diabetes vascular complications and treatment. Endocr Metab Immune Disord Drug Targets 2012;12:179-196.
12. Peters SA, Huxley RR, Woodward M. Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775385 individuals and 12539 strokes. Lancet 2014;383:1973-1980.
13. Stevens RJ, Coleman RL, Adler AI, et al. Risk factors for myocardial infarction case fatality and stroke case fatality in type 2 diabetes: ukpds 66. Diabetes Care 2004;27:201-207.
14. Ho JE, Paultre F, Mosca L. Is diabetes mellitus a cardiovascular disease risk equivalent for fatal stroke in women? Data from the women’s pooling project. Stroke 2003;34:2812-2816.
15. Peters SA, Singhateh Y, Mackay D, Huxley RR, Woodward M. Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis. Atherosclerosis 2016;248:123-131.
16. Hung KH, Lai JCY, Hsu KN, et al. Gender gap and risk factors for poor stroke outcomes: a single hospital-based prospective cohort study. J Stroke Cerebrovasc Dis 2018:27:2250-2258.
17. Gargano JW, Reeves MJ; for the Paul Coverdell National Acute Stroke Registry Michigan Prototype Investigators. Sex differences in stroke recovery and stroke-specific quality of life; results from a statewide stroke registry. Stroke 2007;38:2541-2548.
18. Caso V, Paciaroni M, Agnelli G, et al. Gender differences in patients with acute ischemic stroke. Womens Health (Lond) 2010;6:51-57.
19. Stróżyńska E, Fiszer U, Ryglewicz D, Jacek Zaborski J. The impact of risk burden differences between men and women on the clinical course of ischemic stroke. J Stroke Cerebrovasc Dis 2016;25:843-847.
20. Frid P, Drake M, Giese AK, et al. Stroke Genetics Network (SiGN), the International Stroke Genetics Consortium (ISGC), and the MRI-Genetics Interface Exploration (MRI-GENIE) Study. Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study. J Neurol 2020;267:649-658.
21. Foroozanfar Z, Abdi S, Parsaeian M, et al. Sex differences in 28-day mortality of ıschemic stroke in ıran and ıts associated factors: a prospective cohort study. J Stroke Cerebrovasc Dis 2020;29:104896.
22. Seshadri S, Beiser A, Kelly-Hayes M, et al. The lifetime risk of stroke: estimates from the Framingham Study. Stroke 2006;37:345-350.

APA	Aslanbaba Bahadir E, Sorgun M, Ozaydin Aksun Z, Allahverdiyev T, Bulut O, erdogan s, karaarslan f, Nadirova A, Ölmez B, Önder C, Sahin T, Yalap Ö, Yavuz Z, Yılmaz A, Erdoğan M, TOGAY ISIKAY C (2021). Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females. , 187 - 191. 10.4274/tnd.2021.09086
Chicago	Aslanbaba Bahadir Eda,Sorgun Mine Hayriye,Ozaydin Aksun Zerin,Allahverdiyev Tehran,Bulut Onur,erdogan seyda,karaarslan fatma tuğra,Nadirova Aygul,Ölmez Büşra,Önder Canay,Sahin Turgut,Yalap Ömer Eray,Yavuz Zehra,Yılmaz Abdullah Yasir,Erdoğan Mustafa,TOGAY ISIKAY CANAN Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females. (2021): 187 - 191. 10.4274/tnd.2021.09086
MLA	Aslanbaba Bahadir Eda,Sorgun Mine Hayriye,Ozaydin Aksun Zerin,Allahverdiyev Tehran,Bulut Onur,erdogan seyda,karaarslan fatma tuğra,Nadirova Aygul,Ölmez Büşra,Önder Canay,Sahin Turgut,Yalap Ömer Eray,Yavuz Zehra,Yılmaz Abdullah Yasir,Erdoğan Mustafa,TOGAY ISIKAY CANAN Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females. , 2021, ss.187 - 191. 10.4274/tnd.2021.09086
AMA	Aslanbaba Bahadir E,Sorgun M,Ozaydin Aksun Z,Allahverdiyev T,Bulut O,erdogan s,karaarslan f,Nadirova A,Ölmez B,Önder C,Sahin T,Yalap Ö,Yavuz Z,Yılmaz A,Erdoğan M,TOGAY ISIKAY C Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females. . 2021; 187 - 191. 10.4274/tnd.2021.09086
Vancouver	Aslanbaba Bahadir E,Sorgun M,Ozaydin Aksun Z,Allahverdiyev T,Bulut O,erdogan s,karaarslan f,Nadirova A,Ölmez B,Önder C,Sahin T,Yalap Ö,Yavuz Z,Yılmaz A,Erdoğan M,TOGAY ISIKAY C Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females. . 2021; 187 - 191. 10.4274/tnd.2021.09086
IEEE	Aslanbaba Bahadir E,Sorgun M,Ozaydin Aksun Z,Allahverdiyev T,Bulut O,erdogan s,karaarslan f,Nadirova A,Ölmez B,Önder C,Sahin T,Yalap Ö,Yavuz Z,Yılmaz A,Erdoğan M,TOGAY ISIKAY C "Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females." , ss.187 - 191, 2021. 10.4274/tnd.2021.09086
ISNAD	Aslanbaba Bahadir, Eda vd. "Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females". (2021), 187-191. https://doi.org/10.4274/tnd.2021.09086

APA	Aslanbaba Bahadir E, Sorgun M, Ozaydin Aksun Z, Allahverdiyev T, Bulut O, erdogan s, karaarslan f, Nadirova A, Ölmez B, Önder C, Sahin T, Yalap Ö, Yavuz Z, Yılmaz A, Erdoğan M, TOGAY ISIKAY C (2021). Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females. Türk Nöroloji Dergisi, 27(2), 187 - 191. 10.4274/tnd.2021.09086
Chicago	Aslanbaba Bahadir Eda,Sorgun Mine Hayriye,Ozaydin Aksun Zerin,Allahverdiyev Tehran,Bulut Onur,erdogan seyda,karaarslan fatma tuğra,Nadirova Aygul,Ölmez Büşra,Önder Canay,Sahin Turgut,Yalap Ömer Eray,Yavuz Zehra,Yılmaz Abdullah Yasir,Erdoğan Mustafa,TOGAY ISIKAY CANAN Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females. Türk Nöroloji Dergisi 27, no.2 (2021): 187 - 191. 10.4274/tnd.2021.09086
MLA	Aslanbaba Bahadir Eda,Sorgun Mine Hayriye,Ozaydin Aksun Zerin,Allahverdiyev Tehran,Bulut Onur,erdogan seyda,karaarslan fatma tuğra,Nadirova Aygul,Ölmez Büşra,Önder Canay,Sahin Turgut,Yalap Ömer Eray,Yavuz Zehra,Yılmaz Abdullah Yasir,Erdoğan Mustafa,TOGAY ISIKAY CANAN Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females. Türk Nöroloji Dergisi, vol.27, no.2, 2021, ss.187 - 191. 10.4274/tnd.2021.09086
AMA	Aslanbaba Bahadir E,Sorgun M,Ozaydin Aksun Z,Allahverdiyev T,Bulut O,erdogan s,karaarslan f,Nadirova A,Ölmez B,Önder C,Sahin T,Yalap Ö,Yavuz Z,Yılmaz A,Erdoğan M,TOGAY ISIKAY C Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females. Türk Nöroloji Dergisi. 2021; 27(2): 187 - 191. 10.4274/tnd.2021.09086
Vancouver	Aslanbaba Bahadir E,Sorgun M,Ozaydin Aksun Z,Allahverdiyev T,Bulut O,erdogan s,karaarslan f,Nadirova A,Ölmez B,Önder C,Sahin T,Yalap Ö,Yavuz Z,Yılmaz A,Erdoğan M,TOGAY ISIKAY C Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females. Türk Nöroloji Dergisi. 2021; 27(2): 187 - 191. 10.4274/tnd.2021.09086
IEEE	Aslanbaba Bahadir E,Sorgun M,Ozaydin Aksun Z,Allahverdiyev T,Bulut O,erdogan s,karaarslan f,Nadirova A,Ölmez B,Önder C,Sahin T,Yalap Ö,Yavuz Z,Yılmaz A,Erdoğan M,TOGAY ISIKAY C "Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females." Türk Nöroloji Dergisi, 27, ss.187 - 191, 2021. 10.4274/tnd.2021.09086
ISNAD	Aslanbaba Bahadir, Eda vd. "Etiologic Subtypes, Risk Factors and Early Outcome of Acute Ischemic Stroke in Females". Türk Nöroloji Dergisi 27/2 (2021), 187-191. https://doi.org/10.4274/tnd.2021.09086