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.