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

Abstract

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.