David G. Sherman Lecture Award: 15-Year Experience of the Nationwide Multicenter Stroke Registry in Korea

Bae, Hee Joon; Kim, Jun Yup; Kang, Jihoon; Kim, Beom Joon; Han, Moon‐Ku; Choi, Kang‐Ho; Kim, Joon‐Tae; Park, Man‐Seok; Cho, Ki-Hyun; Kim, Baik Kyun; Yum, Kyu Sun; Shin, Dong‐Ick; Kim, Dae-Hyun; Cha, Jae‐Kwan; Gwak, Dong-Seok; Ryu, Wi‐Sun; Kim, Dong‐Eog; Park, Jong‐Moo; Kim, Yong Soo; Kang, Kyusik; Kim, Jae Guk; Lee, Soo Joo; Lee, Minwoo; Oh, Mi‐Sun; Yu, Kyung‐Ho; Lee, Byung‐Chul; Park, Hong‐Kyun; Cho, Yong-Jin; Hong, Keun‐Sik; Kang, Chul-Hoo; Jang, Joong-Goo; Choi, Jay Chol; Jang, Seong Hwa; Park, Hyungjong; Hong, Jeong‐Ho; Sohn, Sung‐Il; Park, Tai Hwan; Park, Sang‐Soon; Kim, Wook‐Joo; Kwon, Jee‐Hyun; Lee, Kyung Bok; Kwon, Doo Hyuk; Lee, Jun; Lee, Keon‐Joo; Lee, Sang-Hwa; Kim, Chul‐Ho; Jeong, Hae-Bong; Park, Kwang‐Yeol; Lee, Ji Sung; Lee, Jun-Young

doi:10.1161/strokeaha.122.039212

Cited by 11 publications

(15 citation statements)

References 47 publications

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“…This investigation leveraged data obtained from the CRCS-K-NIH, a nationwide, prospective, multicenter stroke registry. 17,18 Using a web-based standardized protocol, clinical and demographic data were collected from consecutive patients with AIS admitted to 16 university hospitals between January 2011 and December 2019. This study included patients who (1) were diagnosed with AIS, as evidenced by corresponding stroke lesions observed either on magnetic resonance imaging or computed tomography; (2) had AF diagnosed either before or during the admission of the index event; and (3) were hospitalized within 7 days following symptom onset.…”

Section: Methods Study Populationmentioning

confidence: 99%

“…The detailed definitions of the outcome variables have been described previously. 17,21,22 Participants were prospectively monitored for these outcomes at 3 months and 1 year after the index stroke via structured telephone interviews or surveillance of medical records by stroke research coordinators at each participating center. To ensure data quality, the outcome adjudication committee of the CRCS-K-NIH regularly conducted systematic audits, including institutional visits as needed.…”

Section: Outcome Variablesmentioning

confidence: 99%

“…To ensure data quality, the outcome adjudication committee of the CRCS-K-NIH regularly conducted systematic audits, including institutional visits as needed. 17,22 To determine whether NOAC use mediates the relationship between the calendar year and the primary composite outcome, we performed a mediation analysis using the model and method described by Baron and Kenny 23 and Vanderweele and Vansteelandt. 24 A hypothetical causal inference model, where the calendar year (2011-2019) influences the composite outcome in patients with AF-related AIS, and NOAC use mediates this relationship, is illustrated in Figure 1.…”

Section: Outcome Variablesmentioning

confidence: 99%

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Secular Trends in Outcomes and Impact of Novel Oral Anticoagulants in Atrial Fibrillation–Related Acute Ischemic Stroke

Lee,

et al. 2024

Stroke

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Background: Novel oral anticoagulants (NOACs) are currently recommended for the secondary prevention of stroke in patients with acute ischemic stroke (AIS) accompanied by atrial fibrillation (AF). However, the impact of NOACs on clinical outcomes in real-world practice remains ambiguous. This study analyzes the trend of clinical events in patients with AF-related AIS and determines how much the introduction of NOACs has mediated this trend. Methods: We identified patients with AIS and AF between January 2011 and December 2019 using a multicenter stroke registry. Annual rates of NOAC prescriptions and clinical events within 1 year were evaluated. The primary outcome was a composite of recurrent stroke, myocardial infarction, and all-cause mortality. To assess the mediation effect of NOACs on the relationship between the calendar year and these outcomes, we used natural effect models and conducted exposure-mediator, exposure-outcome, and mediator-outcome analyses using multivariable regression models or accelerated failure time models, adjusting for potential confounders. Results: Among the 12 977 patients with AF-related AIS, 12 500 (average age: 74.4 years; 51.3% male) were analyzed after excluding cases of valvular AF. Between 2011 and 2019, there was a significant decrease in the 1-year incidence of the primary composite outcome from 28.3% to 21.7%, while the NOAC prescription rate increased from 0% to 75.6%. A 1-year increase in the calendar year was independently associated with delayed occurrence of the primary outcome (adjusted time ratio, 1.10 [95% CI, 1.07–1.14]) and increased NOAC prescription (adjusted odds ratio, 2.20 [95% CI, 2.14–2.27]). Increased NOAC prescription was associated with delayed occurrence of the primary outcome (adjusted time ratio, 3.82 [95% CI, 3.17 to 4.61]). Upon controlling for NOAC prescription (mediator), the calendar year no longer influenced the primary outcome (adjusted time ratio, 0.97 [95% CI, 0.94–1.00]). This suggests that NOAC prescription mediates the association between the calendar year and the primary outcome. Conclusions: Our study highlights a temporal reduction in major clinical events or death in Korean patients with AF-related AIS, mediated by increased NOAC prescription, emphasizing NOAC use in this population.

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Section: Methods Study Populationmentioning

confidence: 99%

Section: Outcome Variablesmentioning

confidence: 99%

Section: Outcome Variablesmentioning

confidence: 99%

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Secular Trends in Outcomes and Impact of Novel Oral Anticoagulants in Atrial Fibrillation–Related Acute Ischemic Stroke

Lee,

et al. 2024

Stroke

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“…Details on the CRCS-K-NIH registry are provided elsewhere. 12,13 The following inclusion criteria applied: age 18 to 50 years at presentation, diagnosis of AIS defined as the presence of ischemic symptoms for over 24 hours or a relevant ischemic lesion on diffusion-weighted magnetic resonance imaging, arrival within 7 days from when the stroke symptoms were recognized by the patient (first abnormal time), and hospitalization between April 2008 and December 2019. The patient flowchart is provided as a supplement (Figure S3).…”

Section: Methodsmentioning

confidence: 99%

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

Kim,

Kang

et al. 2023

Stroke

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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.

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“…Detailed information on the CRCS-K-NIH registry is provided elsewhere. 16 We included patients who were aged 18-50 years at presentation, had AIS defined as having ischemic symptoms for more than 24 h or a relevant ischemic lesion on diffusion-weighted MRI, arrived within seven days from when patients recognized stroke symptoms (first abnormal time [FAT]), and were hospitalized between April 2008 and December 2019.…”

Section: Study Populationmentioning

confidence: 99%

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

Kim

Kang

et al. 2023

Preprint

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Background <break>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 (AIS). This study investigated whether advances in these treatments improved outcomes in this population.<break>Methods<break>Using a prospective multicenter stroke registry in Korea, young adults (aged 1850 years) with AIS hospitalized between 2008 and 2019 were identified. The observation period was divided into four epochs: 20082010, 20112013, 20142016, and 20172019. Secular trends for patient characteristics, treatments, and outcomes were analyzed.<break><break>Results<break> A total of 7,050 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 20082010 to 20172019 (9.5% to 13.8% and 3.2% to 9.2%, respectively; Ptrends<0.01). Door-to-needle time improved (Ptrend<0.001), but onset-to-door and door-to-puncture time remained constant. Secondary prevention including dual antiplatelets for noncardioembolic minor stroke (26.7% to 47.0%), direct oral anticoagulants for atrial fibrillation (0.0% to 56.2%), and statins for large artery atherosclerosis (76.1% to 95.3%) increased (Ptrends<0.01). Outcome data were available since 2011. One-year mortality (2.5% in 20112013 and 2.3% in 20172019) and 3-month modified Rankin scale scores 01 (68.3% to 69.1%) and 02 (87.6% to 86.2%) remained unchanged. One-year stroke recurrence rate increased (4.1% to 5.5%, Ptrend=0.04), but was not significant after adjusting for warfarin use.<break> Conclusion<break><break>Improvements in the delivery of acute stroke treatments did not necessarily lead to better outcomes in young adults with AIS over the past decade, indicating a need for further improvement.

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David G. Sherman Lecture Award: 15-Year Experience of the Nationwide Multicenter Stroke Registry in Korea

Cited by 11 publications

References 47 publications

Secular Trends in Outcomes and Impact of Novel Oral Anticoagulants in Atrial Fibrillation–Related Acute Ischemic Stroke

Secular Trends in Outcomes and Impact of Novel Oral Anticoagulants in Atrial Fibrillation–Related Acute Ischemic Stroke

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

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

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