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(Stroke. 2009;40:344.)
© 2009 American Heart Association, Inc.

Original Contributions

The Metabolic Syndrome Is Associated With a Higher Resistance to Intravenous Thrombolysis for Acute Ischemic Stroke in Women Than in Men

Juan F. Arenillas, MD, PhD; Patricio Sandoval, MD; Natalia Pérez de la Ossa, MD; Mónica Millán, MD; Cristina Guerrero, MD; Domingo Escudero, MD, PhD; Laura Dorado, MD; Elena López-Cancio, MD; José Castillo, MD, PhD Antoni Dávalos, MD, PhD

From the Stroke Unit (J.F.A., P.S., N.P.d.l.O., M.M., C.G., D.E., L.D., E.L.-C., A.D.), Department of Neurosciences, Germans Trias i Pujol Universitary Hospital, Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain; Departmento de Neurología (P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; Clinical Neuroscience Research Laboratory (J.C.), Division of Vascular Neurology, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain; and the Stroke Unit (J.F.A.), Department of Neurology, Hospital Clínico Universitario, University of Valladolid, Valladolid, Spain.

Correspondence to Dr Juan F. Arenillas Lara, Stroke Unit, Department of Neurology, Hospital Clínico Universitario, University of Valladolid, Avda Ramón y Cajal 3, 47005 Valladolid, Spain. E-mail juanfarenillas{at}gmail.com

Background and Purpose— The metabolic syndrome (MetS) might confer a higher resistance to intravenous thrombolysis in acute middle cerebral artery (MCA) ischemic stroke. MetS increases the risk of stroke in women to a greater extent than in men. We aimed to investigate whether there might be sex differences in the impact of MetS on the response to intravenous thrombolysis for acute MCA ischemic stroke.

Methods— We prospectively studied consecutive ischemic stroke patients, treated with intravenous tissue-type plasminogen activator according to SITS-MOST criteria, with an MCA occlusion on prebolus transcranial Doppler examination. Resistance to thrombolysis was defined as the absence of complete MCA recanalization 24 hours after tissue-type plasminogen activator infusion by transcranial Doppler criteria. MetS was diagnosed according to the criteria established by the American Heart Association/National Heart, Lung, and Blood Institute 2005 statement.

Results— A total of 125 patients (75 men, 50 women; mean age, 67.6±11 years) were included. MetS was diagnosed in 76 (61%) patients. Resistance to clot lysis at 24 hours was observed in 53 (42%) patients. Two multivariate-adjusted, logistic-regression models identified that MetS was associated with a higher resistance to tissue-type plasminogen activator, independently of other significant baseline variables (odds ratio=9.8; 95% CI, 3.5 to 27.8; P=0.0001) and of the individual components of the MetS. The MetS was associated with a significantly higher odds of resistance to thrombolysis in women (odds ratio=17.5; 95% CI, 1.9 to 163.1) than in men (odds ratio=5.1; 95% CI, 1.6 to 15.6; P for interaction=0.0004).

Conclusions— The effect of MetS on the resistance to intravenous thrombolysis for acute MCA ischemic stroke appears to be more pronounced in women than in men.

Key Words: acute stroke • thrombolysis • outcome • metabolic syndrome • sex differences

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