Change of mortality of patients with acute ischemic stroke before and after 2015

Sang-Won Park; Ji Young Lee; Nam Hun Heo; James Jisu Han; Eun Chae Lee; Dong-Yong Hong; Dong-Hun Lee; Byung Cheol Lee; Young Wha Lim; Gui Ok Kim; Man Ryul Lee; Jae Sang Oh

doi:10.3389/fneur.2022.947992

Change of mortality of patients with acute ischemic stroke before and after 2015

Front Neurol. 2022 Aug 24:13:947992. doi: 10.3389/fneur.2022.947992. eCollection 2022.

Authors

Affiliations

¹ Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, South Korea.
² Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, United States.
³ Health Insurance Review and Assessment Service (HIRA), Chuncheon, South Korea.
⁴ Soonchunhyang Institute of Medi-Bio Science (SIMS), Soonchunhyang University, Cheonan, South Korea.

Abstract

Introduction: Advances in the diagnosis and management of acute ischemic stroke (AIS) and the increased use of mechanical thrombectomy (MT) have improved the quality of care and prognosis of patients with AIS since 2015. We investigated the changing trends in mortality of patients with AIS in Korea before and after 2015.

Materials and methods: A retrospective cohort study was conducted using combined anonymized data from the Acute Stroke Assessment Registry of Korea and the Health Insurance Review & Assessment Service database. Patients with ischemic stroke with precise onset time and initial National Institute of Health Stroke Scale records were included.

Results: Patients receiving MT treatment increased from 256 (2.7%) pre-2015 to 1,037 (3.9%) post-2015 (p < 0.001). Overall mortality significantly decreased from pre-2015 to post-2015. In pre-2015, intravenous thrombolysis (IVT) administered within 2 h significantly reduced 3-month mortality when compared with non-IVT. While, in post-2015, IVT administered within 2 h significantly reduced the 3-month, 1-year, 2-year, and 4-year mortality (p < 0.05). MT only reduced 1-year mortality pre-2015; however, MT significantly reduced the 3-month, 1-year, and 2-year mortality post-2015 (p < 0.05). Post-stroke antiplatelet and anticoagulant drugs significantly reduced the 3-month, 1-year, 2-year, and 4-year mortality post-2015.

Discussion: Since 2015, faster IVT has significantly reduced the short- and long-term mortality in patients with AIS; MT reduced the 3-month, 1-year, and 2-year mortality. Post-stroke antithrombotic medication has significantly lowered the 2- and 4-year mortality since 2015.

Conclusions: Changing trends in AIS management since 2015 have improved the prognosis of patients with AIS.

Keywords: acute ischemic stroke; intravenous thrombolysis (IVT); mechanical thrombectomy (MT); stroke; stroke care; trend research.