Abstract 11: Sex differences in the association of brain frailty measures with functional outcomes after endovascular treatment: analysis of the ESCAPE-NA1 trial
Bibliographic record
Abstract
Background: Sex differences have been observed in functional outcomes after endovascular thrombectomy (EVT). Brain frailty markers like atrophy and small vessel disease burden have been shown to be associated with EVT outcomes. We aimed to investigate the association between imaging markers of brain frailty and functional outcomes after EVT in women and men. Methods: This study is a post hoc analysis of the ESCAPE-NA1 trial that evaluated the efficacy and safety of nerinetide in patients with large vessel occlusion receiving EVT within 12 hours of onset. Baseline CT was used to assess brain frailty markers including atrophy score, inter-caudate distance to inner table width ratio [CC/IT ratio]), white matter disease (Fazekas score), presence of lacunes and old infarctions, and follow-up MRI was used to assess microbleed and lacunes burden. Outcomes included the modified Rankin Scale (mRS) at 90 days (dichotomized as 0-2 vs 3-6, and ordinal/shift analysis). Multivariable logistic regression models were used to examine the association between imaging frailty measures and 90-day mRS separately in women and men. Results: A total of 1,102 participants (mean age 69.5 ± 13.7 years, 548 women) were analyzed. Women were older (74 vs. 69 years, p<0.0001), less likely to smoke (38% vs. 60%, p<0.0001), and had a lower baseline NIHSS (16 [12–21] vs. 17 [13–21], p=0.009), compared to men. Regarding imaging frailty measures, women had a lower CC/IT ratio (0.12 [0.09–0.15] vs. 0.13 [0.10–0.15], p=0.01), a higher Fazekas score (1 [0–2] vs. 0 [0–2], p<0.0001), and more frequent lacunes (27% vs. 22%, p=0.04). In the multivariable analyses, imaging frailty measures were generally associated with worse outcomes at 90-days; however, significant associations between these markers and 90-day mRS were observed only in women and not in men. CT-based markers such as cortical and subcortical atrophy, CC/IT ratio, old infarction carried significantly lower odds of 90-day mRS 0-2 in women but not men (Figure 1). Similar findings were also seen on shift analyses of the mRS. However, there were no statistically significant interactions by sex for these brain frailty measures. Conclusion: In this cohort of EVT recipients, significant associations between imaging brain frailty measures and 90-day outcomes were seen only in women and not in men. These findings merit validation in other cohorts as they suggest sex differences in the effects of brain frailty on post-stroke outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".