Improvement in Delivery of Ischemic Stroke Treatments but Stagnation of Clinical Outcomes in Young Adults in South Korea-Reference-Cited by-同舟云学术

Improvement in Delivery of Ischemic Stroke Treatments but Stagnation of Clinical Outcomes in Young Adults in South Korea

Published:2023-12 Issue:12 Volume:54 Page:3002-3011
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Kim Jonguk¹^ORCID,Kim Jun Yup¹^ORCID,Kang Jihoon¹^ORCID,Kim Beom Joon¹,Han Moon-Ku¹,Lee Jeong-Yoon¹^ORCID,Park Tai Hwan²^ORCID,Lee Keon-Joo³^ORCID,Kim Joon-Tae⁴^ORCID,Choi Kang-Ho⁴^ORCID,Park Jong-Moo⁵,Kang Kyusik⁶^ORCID,Lee Soo Joo⁷^ORCID,Kim Jae Guk⁷^ORCID,Cha Jae-Kwan⁸^ORCID,Kim Dae-Hyun⁸^ORCID,Lee Kyungbok⁹^ORCID,Lee Jun¹⁰^ORCID,Hong Keun-Sik¹¹,Cho Yong-Jin¹¹^ORCID,Park Hong-Kyun¹¹^ORCID,Lee Byung-Chul¹²^ORCID,Yu Kyung-Ho¹²^ORCID,Oh Mi-Sun¹²,Kim Dong-Eog¹³,Ryu Wi-Sun¹³,Choi Jay Chol¹⁴^ORCID,Kwon Jee-Hyun¹⁵^ORCID,Kim Wook-Joo¹⁵^ORCID,Shin Dong-Ick¹⁶^ORCID,Yum Kyu Sun¹⁶^ORCID,Sohn Sung Il¹⁷,Hong Jeong-Ho¹⁷^ORCID,Lee Sang-Hwa¹⁸,Lee Ji Sung¹⁹^ORCID,Lee Juneyoung²⁰^ORCID,Gorelick Philip B.²¹^ORCID,Bae Hee-Joon¹^ORCID

Affiliation:

1. Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (J. Kim , J.Y.K., J.K., B.J.K., M.-K.H., J.-Y.L., H.-J.B.).

2. Department of Neurology, Seoul Medical Center, Korea (T.H.P.).

3. Korea University Guro Hospital, Seoul, Korea (K.-J.L.).

4. Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K., K.-H.C.).

5. Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Korea (J.-M.P.).

6. Department of Neurology, Nowon Eulji Medical Center, Department of Neurology, Eulji University School of Medicine, Seoul, Korea (K.K.).

7. Eulji University Hospital, Daejeon, Korea (S.J.L., J.G.K.).

8. Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.).

9. Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.L.).

10. Department of Neurology, Yeungnam University Medical Center, Daegu, Korea (J.L.).

11. Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.).

12. Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.-S.O.).

13. Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.).

14. Department of Neurology, Jeju National University Hospital, Korea (J.C.C.).

15. Department of Neurology, Ulsan University Hospital, Korea (J.-H.W., W.-J.K.).

16. Department of Neurology, Chungbuk National University and Hospital, Cheongju, Korea (D.-I.S., K.S.Y.).

17. Department of Neurology, Keimyung University Dongsan Hospital, Daegu, Korea (S.I.S., J.H.).

18. Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea (S.-H.L.).

19. Clinical Research Center, Asan Medical Center, Seoul, Korea (J.S.L.).

20. Department of Biostatistics, Korea University, Seoul, Korea (J.L.).

21. Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.B.G).

Abstract

BACKGROUND: There is limited information on the delivery of acute stroke therapies and secondary preventive measures and clinical outcomes over time in young adults with acute ischemic stroke. This study investigated whether advances in these treatments improved outcomes in this population. METHODS: Using a prospective multicenter stroke registry in Korea, young adults (aged 18–50 years) with acute ischemic stroke hospitalized between 2008 and 2019 were identified. The observation period was divided into 4 epochs: 2008 to 2010, 2011 to 2013, 2014 to 2016, and 2017 to 2019. Secular trends for patient characteristics, treatments, and outcomes were analyzed. RESULTS: A total of 7050 eligible patients (mean age, 43.1; men, 71.9%) were registered. The mean age decreased from 43.6 to 42.9 years ( P trend =0.01). Current smoking decreased, whereas obesity increased. Other risk factors remained unchanged. Intravenous thrombolysis and mechanical thrombectomy rates increased over time from 2008 to 2010 to 2017 to 2019 (9.5%–13.8% and 3.2%–9.2%, respectively; P trend <0.01). Door-to-needle time improved ( P trend <.001), but onset-to-door and door-to-puncture times remained constant. Secondary prevention, including dual antiplatelets for noncardioembolic minor stroke (26.7%–47.0%), direct oral anticoagulants for atrial fibrillation (0.0%–56.2%), and statins for large artery atherosclerosis (76.1%–95.3%) increased ( P trend <0.01). Outcome data were available from 2011. One-year mortality (2.5% in 2011–2013 and 2.3% in 2017–2019) and 3-month modified Rankin Scale scores 0 to 1 (68.3%–69.1%) and 0 to 2 (87.6%–86.2%) remained unchanged. The 1-year stroke recurrence rate increased (4.1%–5.5%; P trend =0.04), although the difference was not significant after adjusting for sex and age. CONCLUSIONS: Improvements in the delivery of acute stroke treatments did not necessarily lead to better outcomes in young adults with acute ischemic stroke over the past decade, indicating a need for further progress.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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