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

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Author(s)
Jonguk KimJun Yup KimJihoon KangBeom Joon KimMoon-Ku HanJeong-Yoon LeeTai Hwan ParkKeon-Joo LeeJoon-Tae KimKang-Ho ChoiJong-Moo ParkKyusik KangSoo Joo LeeJae Guk KimJae-Kwan ChaDae-Hyun KimKyungbok LeeJun LeeKeun-Sik HongYong-Jin ChoHong-Kyun ParkByung-Chul LeeKyung-Ho YuMi-Sun OhDong-Eog KimWi-Sun RyuJay Chol ChoiJee-Hyun KwonWook-Joo KimDong-Ick ShinKyu Sun YumSung Il SohnJeong-Ho HongSang-Hwa LeeJi Sung LeeJuneyoung LeePhilip B GorelickHee-Joon Bae
Keimyung Author(s)
Sohn, Sung IlHong, Jeong Ho
Department
Dept. of Neurology (신경과학)
Journal Title
Stroke
Issued Date
2023
Volume
54
Issue
12
Keyword
atherosclerosisatrial fibrillationischemic strokestrokeyoung adult
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 (Ptrend=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; Ptrend<0.01). Door-to-needle time improved (Ptrend <.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 (Ptrend<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%; Ptrend=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.
Keimyung Author(s)(Kor)
손성일
홍정호
Publisher
School of Medicine (의과대학)
College of Nursing (간호대학)
Type
Article
ISSN
1524-4628
Source
https://www.ahajournals.org/doi/10.1161/STROKEAHA.123.044619
DOI
10.1161/STROKEAHA.123.044619
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45586
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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