Case Characteristics, Hyperacute Treatment, and Outcome Information from the Clinical Research Center for Stroke-Fifth Division Registry in South Korea
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Characteristics of stroke cases, acute stroke care, and outcomes after stroke differ according to geographical and cultural background. To provide epidemiological and clinical data on stroke care in South Korea, we analyzed a prospective multicenter clinical stroke registry, the Clinical Research Center for Stroke-Fifth Division (CRCS-5). Patients were 58% male with a mean age of 67.2±12.9 years and median National Institutes of Health Stroke Scale score of 3 [1-8] points. Over the 6 years of operation, temporal trends were documented including increasing utilization of recanalization treatment with shorter onset-to-arrival delay and decremental length of stay. Acute recanalization treatment was performed in 12.7% of cases with endovascular treatment utilized in 36%, but the proportion of endovascular recanalization varied across centers. Door-to-IV alteplase delay had a median of 45 [33-68] min. The rate of symptomatic hemorrhagic transformation (HT) was 7%, and that of any HT was 27% among recanalization-treated cases. Early neurological deterioration occurred in 15% of cases and were associated with longer length of stay and poorer 3-month outcomes. The proportion of mRS scores of 0-1 was 42% on discharge, 50% at 3 months, and 55% at 1 year after the index stroke. Recurrent stroke up to 1 year occurred in 4.5% of patients; the rate was higher among older individuals and those with neurologically severe deficits. The above findings will be compared with other Asian and US registry data in this article.
Abstract
Characteristics of stroke cases, acute stroke care, and outcomes after stroke differ according to geographical and cultural background. To provide epidemiological and clinical data on stroke care in South Korea, we analyzed a prospective multicenter clinical stroke registry, the Clinical Research Center for Stroke-Fifth Division (CRCS-5). Patients were 58% male with a mean age of 67.2±12.9 years and median National Institutes of Health Stroke Scale score of 3 [1-8] points. Over the 6 years of operation, temporal trends were documented including increasing utilization of recanalization treatment with shorter onset-to-arrival delay and decremental length of stay. Acute recanalization treatment was performed in 12.7% of cases with endovascular treatment utilized in 36%, but the proportion of endovascular recanalization varied across centers. Door-to-IV alteplase delay had a median of 45 [33-68] min. The rate of symptomatic hemorrhagic transformation (HT) was 7%, and that of any HT was 27% among recanalization-treated cases. Early neurological deterioration occurred in 15% of cases and were associated with longer length of stay and poorer 3-month outcomes. The proportion of mRS scores of 0-1 was 42% on discharge, 50% at 3 months, and 55% at 1 year after the index stroke. Recurrent stroke up to 1 year occurred in 4.5% of patients; the rate was higher among older individuals and those with neurologically severe deficits. The above findings will be compared with other Asian and US registry data in this article.
참고문헌 (45)
- Bufalino VJ, "The American Heart Association’s recommendations for expanding the applications of existing and future clinical registries: a policy statement from the American Heart Association", Circulation, 123, pp.2167~2179 (2011)
- Gliklich RE, "Registries for Evaluating Patient Outcomes: A User’s Guide" (2010), Agency for Healthcare Research and Quality (US)
- Maasland L, "Patients enrolled in large randomized clinical trials of antiplatelet treatment for prevention after transient ischemic attack or ischemic stroke are not representative of patients in clinical practice: the Netherlands Stroke Survey", Stroke, 40, pp.2662~2668 (2009)
- Hammill BG, "Linking inpatient clinical registry data to Medicare claims data using indirect identifiers", Am Heart J, 157, pp.995~1000 (2009)
- Lee BC, "International Experience in Stroke Registries", Am J Prev Med, 31, pp.S243~S245 (2006)
- Kim BJ, "Current status of acute stroke management in Korea: a report on a multicenter, comprehensive acute stroke registry", Int J Stroke, 9, pp.514~518 (2014)
- Maeda K, "Effects of Sex Difference on Clinical Features of Acute Ischemic Stroke in Japan", J Stroke Cerebrovasc Dis, 22, pp.1070~1075 (2013)
- Hsieh FI, "Stroke: morbidity, risk factors, and care in taiwan", J Stroke, 16, pp.59~64 (2014)
- Tong D, "Times From Symptom Onset to Hospital Arrival in the Get With The Guidelines-Stroke Program 2002 to 2009: Temporal Trends and Implications", Stroke, 43, pp.1912~1917 (2012)
- Keun-Sik Hong, "Stroke Statistics in Korea: Part I. Epidemiology and Risk Factors: A Report from the Korean Stroke Society and Clinical Research Center for Stroke", 대한뇌졸중학회지, 15(1), pp.2~20 (2013), 대한뇌졸중학회[DOI]
- Béjot Y, "Poststroke disposition and associated factors in a population-based study: the Dijon Stroke Registry", Stroke, 43, pp.2071~2077 (2012)
- Qureshi AI, "Discharge destination as a surrogate for Modified Rankin Scale defined outcomes at 3- and 12-months poststroke among stroke survivors", Arch Phys Med Rehabil, 93, pp.1408~1413 (2012)
- Schwamm LH, "Temporal Trends in Patient Characteristics and Treatment With Intravenous Thrombolysis Among Acute Ischemic Stroke Patients at Get With the Guidelines-Stroke Hospitals", Circ Cardiovasc Qual Outcome, 6, pp.543~549 (2013)
- Cheng S, "Temporal Trends in the Population Attributable Risk for Cardiovascular Disease: The Atherosclerosis Risk in Communities Study", Circulation, 130, pp.820~828 (2014)
- Kaur P, "Cost of stroke in low and middle income countries: a systematic review", Int J Stroke, 9, pp.678~682 (2014)
- Deng Y, "Reduction of length of stay and costs through the implementation of clinical pathways for stroke management in China", Stroke, 45, pp.e81~e83 (2014)
- Fonarow GC, "Characteristics, Performance Measures, and In-Hospital Outcomes of the First One Million Stroke and Transient Ischemic Attack Admissions in Get With The Guidelines-Stroke", Circ Cardiovasc Qual Outcome, 3, pp.291~302 (2010)
- Emberson J, "Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials", Lancet, 384, pp.1929~1935 (2014)
- ): a randomised controlled trial, "Lancet", 2012, 2352~2363
- Chao AC, "Outcomes of Thrombolytic Therapy for Acute Ischemic Stroke in Chinese Patients: The Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study", Stroke, 41, pp.885~890 (2010)
- Hassan AE, "National trends in utilization and outcomes of endovascular treatment of acute ischemic stroke patients in the mechanical thrombectomy era", Stroke, 43, pp.3012~3017 (2012)
- Saver JL, "Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial", Lancet, 380, pp.1241~1249 (2012)
- Nogueira RG, "Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke(TREVO 2) : a randomised trial", Lancet, 380, pp.1231~1240 (2012)
- Mokin M, "Solitaire Flow Restoration Thrombectomy for Acute Ischemic Stroke: Retrospective Multicenter Analysis of Early Postmarket Experience After FDA Approval", Neurosurgery, 73, pp.19~26 (2013)
- Broderick JP, "Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke", N Engl J Med, 368, pp.893~903 (2013)
- Ciccone A, "Endovascular Treatment for Acute Ischemic Stroke", N Engl J Med, 368, pp.904~913 (2013)
- Kidwell CS, "A Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke", N Engl J Med, 368, pp.914~923 (2013)
- Wang Z, "Gender Differences in 1-Year Clinical Characteristics and Outcomes after Stroke: Results from the China National Stroke Registry", PLoS ONE, 8, pp.e56459~ (2013)
- Petty GW, "Ischemic Stroke Subtypes : A Population-Based Study of Functional Outcome, Survival, and Recurrence", Stroke, 31, pp.1062~1068 (2000)
- Lovett JK, "Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies", Neurology, 62, pp.569~573 (2004)
- Jackson C, "Comparing risks of death and recurrent vascular events between lacunar and non-lacunar infarction", Brain, 128, pp.2507~2517 (2005)
- Hong KS, "Impact of neurological and medical complications on 3-month outcomes in acute ischaemic stroke", Eur J Neurol, 15, pp.1324~1331 (2008)
- Weimar C, "Neurologic worsening during the acute phase of ischemic stroke", Arch Neurol, 62, pp.393~397 (2005)
- Petty GW, "Survival and recurrence after first cerebral infarction A population-based study in Rochester, Minnesota, 1975 through 1989", Neurology, 50, pp.208~216 (1998)
- Hankey GJ, "Long-Term Risk of First Recurrent Stroke in the Perth Community Stroke Study", Stroke, 29, pp.2491~2500 (1998)
- Hillen T, "Cause of Stroke Recurrence Is Multifactorial: Patterns, Risk Factors, and Outcomes of Stroke Recurrence in the South London Stroke Register", Stroke, 34, pp.1457~1463 (2003)
- WHO MONICA Proejct Principal Investigators, "The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators", J Clin Epidemiol, 41, pp.105~114 (1988)
- Antithrombotic Trialists’ Collaboration, "Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients", BMJ, 324, pp.71~86 (2002)
- Dhamoon MS, "Recurrent stroke and cardiac risks after first ischemic stroke: The Northern Manhattan Study", Neurology, 66, pp.641~646 (2006)
- Ohman EM, "The REduction of Atherothrombosis for Continued Health (REACH) Registry: An international, prospective, observational investigation in subjects at risk for atherothrombotic events-study design", Am Heart J, 151, pp.786~ (2006)
- Hsieh FI, "Get With The Guidelines-Stroke Performance Indicators: Surveillance of Stroke Care in the Taiwan Stroke Registry: Get With The Guidelines-Stroke in Taiwan", Circulation, 122, pp.1116~1123 (2010)
- Kimura K, "Analysis of 16,922 Patients with Acute Ischemic Stroke and Transient Ischemic Attack in Japan", Cerebrovasc Dis, 18, pp.47~56 (2004)
- Fonarow GC, "Characteristics, performance measures, and in-hospital outcomes of the first one million stroke and transient ischemic attack admissions in get with the guidelines-stroke", Circ Cardiovasc Quality Outcome, 3, pp.291~302 (2010)
- Wang Y, "The China National Stroke Registry for patients with acute cerebrovascular events: design, rationale, and baseline patient characteristics", Int J Stroke, 6, pp.355~361 (2011)
- Wang Y, "Using Recombinant Tissue Plasminogen Activator to Treat Acute Ischemic Stroke in China : Analysis of the Results From the Chinese National Stroke Registry(CNSR)", Stroke, 42, pp.1658~1664 (2011)