Sex-Related Differences in Endovascular Treatment Outcomes for Acute Large Infarcts: The ANGEL-ASPECT Subanalysis.

IF 7.8 1区医学 Q1 CLINICAL NEUROLOGY

Stroke Pub Date : 2025-05-09 DOI:10.1161/STROKEAHA.124.050025

Dapeng Sun, Xin Guo, Li Ling, Liwen Jiao, Thanh N Nguyen, Mohamad Abdalkader, Yuesong Pan, Mengxing Wang, Gang Luo, Baixue Jia, Xu Tong, Ning Ma, Feng Gao, Dapeng Mo, Raynald, Xiaochuan Huo, Zhongrong Miao

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引用次数: 0

Abstract

Background: The outcomes of endovascular therapy (EVT) across sexes for large infarcts remain unclear. This study aimed to evaluate the impact of sex on the outcomes of EVT or medical management for patients with large infarcts.

Methods: In this secondary analysis of the ANGEL-ASPECT (Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core) randomized controlled trial conducted at 46 stroke centers across China between October 2, 2020, and May 18, 2022, we compared baseline characteristics and clinical outcomes between males and females, and each cohort further divided into EVT and medical management groups. The primary outcome was the 90-day modified Rankin Scale score distribution. Safety outcomes included symptomatic intracranial hemorrhage within 48 hours and mortality within 90 days.

Results: There were 176 of 455 patients enrolled in the ANGEL-ASPECT trial who were female. There were 54.0% (95/176) of females and 48.4% (135/279) of males who underwent EVT. The treatment effect of EVT did not vary in both sexes with large infarcts (all P>0.05 for interaction). Compared with medical management, EVT improved 90-day functional outcomes for both males (3 [2-5] versus 4 [3-5]; common odds ratio, 1.94 [95% CI, 1.27-2.97]; P=0.002) and females (4 [3-6] versus 5 [4-6]; common odds ratio, 2.50 [95% CI, 1.41-4.45]; P=0.002). The symptomatic intracranial hemorrhage rate was not different in both treatment groups across both sexes (males, 5.2% versus 2.8%; odds ratio, 2.05 [95% CI, 0.56-7.50]; P=0.278; females, 7.4% versus 2.5%; odds ratio, 2.89 [95% CI, 0.55-15.14]; P=0.210).

Conclusions: In patients with large ischemic core, the treatment effect of EVT did not differ between females and males, with better outcomes with EVT versus medical management, without an increased risk of symptomatic intracranial hemorrhage. These findings emphasize the need for equal attention and care for both sexes with large infarcts in clinical practice.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04551664.

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急性大面积梗死血管内治疗结果的性别差异：ANGEL-ASPECT亚分析

背景：血管内治疗（EVT）治疗大面积梗死的男女结果尚不清楚。本研究旨在评估性别对大面积梗死患者EVT结局或医疗管理的影响。方法：对2020年10月2日至2022年5月18日在中国46个卒中中心进行的ANGEL-ASPECT（血管内治疗急性前循环大血管闭塞患者伴大梗死核心）随机对照试验进行二次分析，我们比较了男性和女性的基线特征和临床结果，并将每个队列进一步分为EVT组和医疗管理组。主要观察指标为90天修正兰金量表评分分布。安全性结果包括48小时内出现症状性颅内出血，90天内死亡。结果：ANGEL-ASPECT试验纳入的455例患者中有176例为女性。女性占54.0%(95/176)，男性占48.4%（135/279）。EVT的治疗效果在大梗死的男女患者中没有差异（相互作用均P < 0.05）。与医疗管理相比，EVT改善了两名男性的90天功能结局(3[2-5]对4 [3-5]；共同优势比为1.94 [95% CI, 1.27-2.97]；P=0.002)和女性(4[3-6]对5 [4-6]；常见优势比为2.50 [95% CI, 1.41-4.45]；P = 0.002)。两种治疗组的症状性颅内出血率在两性之间没有差异(男性，5.2%对2.8%；优势比，2.05 [95% CI, 0.56-7.50]；P = 0.278;女性，7.4%对2.5%；优势比2.89 [95% CI, 0.55-15.14]；P = 0.210)。结论：在大缺血核心患者中，EVT的治疗效果在女性和男性之间没有差异，EVT治疗效果优于药物治疗，没有增加症状性颅内出血的风险。这些发现强调了在临床实践中对大面积梗死患者男女平等关注和护理的必要性。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT04551664。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.