Long-Term Trends in Ischemic Stroke Incidence and Risk Factors: Perspectives from an Asian Stroke Registry

Tan, Benjamin Yong‐Qiang; Tan, Joshua T C; Cheah, Dawn; Zheng, Huili; Pek, Pin Pin; Silva, Deidre Anne De; Ahmad, Aftab; Chan, Bernard; Chang, Hui Meng; Kong, Keng He; Young, Sherry; Tang, Kok Foo; Tu, Tian Ming; Yeo, Leonard Leong‐Litt; Venketasubramanian, Narayanaswamy; Ho, Andrew Fu Wah; Ong, Marcus Eng Hock

doi:10.5853/jos.2020.00878

Cited by 11 publications

(9 citation statements)

References 9 publications

(15 reference statements)

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“…Contrary to other studies indicating a rise in major vascular risk factors, 14,16,28 our study found an unexpected decrease in the prevalence of hypertension and atrial fibrillation, despite an older population (Table 1). In Korea, hypertension management has improved considerably, leading to a reduced prevalence of hypertension in the general population from 1998 to 2018.…”

Section: Discussioncontrasting

confidence: 99%

Temporal Trends in Stroke Management and Outcomes between 2011 and 2020: Results from a Nationwide Multicenter Registry

Park,

Hong,

Cho

et al. 2024

Preprint

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BackgroundThere have been significant advancements in the treatment of ischemic stroke including stent retrievers for endovascular thrombectomy, new oral anticoagulants for atrial fibrillation, dual antiplatelet therapy for stroke prevention, and statins for atherosclerotic stroke. This study aims to evaluate temporal trends of these treatments and related clinical outcomes through a decade-long trend analysis, utilizing data from a comprehensive, national, multicenter stroke registry. We also seek to identify areas in need of improvement.MethodsThis analysis involved patients with ischemic stroke or transient ischemic attack registered prospectively in the Clinical Research Center for Stroke-Korea-National Institute of Health (CRCS-K-NIH) registry between 2011 and 2020. We examined temporal trends in risk factors, etiologic subtypes, acute management strategies, and outcomes for up to one year post-stroke. Generalized linear mixed models were employed to account for center clustering.ResultsAmong 77,662 patients over 10 years, the average age increased by 2.2 years in men and 2.4 years in women. Notably, in-hospital neurological deterioration, 3-month and 1-year mortality, and cumulative incidence of recurrent stroke within one year showed significant decreases over time after adjustments for age, sex, and initial stroke severity (Ptrend’s< 0.01). However, functional outcomes at 3 months and 1 year remained unchanged. The use of endovascular thrombectomy increased from 5.4% in 2011 to 10.6% in 2020. There was also an increase in the prescription of anticoagulants for atrial fibrillation, dual antiplatelet therapy, statins, and stroke unit care. Contrarily, the rate of intravenous thrombolysis showed a slight decline.ConclusionsThis study points to a reduction in mortality and risk of recurrent stroke over the past decade, paralleling enhancement in acute and preventive stroke management. Nevertheless, the decline in use of intravenous thrombolysis and the stagnation of functional outcomes may signal the need for further investigation to identify underlying causes of these trends and counterstrategies to mitigate risks.

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Section: Discussioncontrasting

confidence: 99%

Temporal Trends in Stroke Management and Outcomes between 2011 and 2020: Results from a Nationwide Multicenter Registry

Park,

Hong,

Cho

et al. 2024

Preprint

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“…As there is a high prevalence of stroke patients who have concomitant diabetes in our local population (43.2%) 52 , and patients with diabetes are known to have poorer post-thrombolysis stroke outcomes compared to those without diabetes 53 , we proceeded to perform a subgroup analysis comparing the outcomes of patients with and without diabetes. Our study observed no association between TyG index and stroke outcomes in patients with diabetes, although the association with mortality and poorer functional outcomes was approaching statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Association of triglyceride-glucose index with clinical outcomes in patients with acute ischemic stroke receiving intravenous thrombolysis

Toh

Lim

Ming

et al. 2022

Sci Rep

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Intravenous tissue plasminogen activator (tPA) remains the cornerstone of recanalization therapy for acute ischemic stroke (AIS), albeit with varying degrees of response. The triglyceride-glucose (TyG) index is a novel marker of insulin resistance, but association with outcomes among AIS patients who have received tPA has not been well elucidated. We studied 698 patients with AIS who received tPA from 2006 to 2018 in a comprehensive stroke centre. TyG index was calculated using the formula: ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. TyG index was significantly lower in patients that survived at 90-days than those who died (8.61 [Interquartile Range: 8.27–8.99] vs 8.76 [interquartile range: 8.39–9.40], p = 0.007). In multivariate analysis, TyG index was significantly associated with 90-day mortality (OR: 2.12, 95% CI: 1.39–3.23, p = 0.001), poor functional outcome (OR: 1.41 95% CI: 1.05–1.90, p = 0.022), and negatively associated with early neurological improvement (ENI) (OR: 0.68, 95% CI: 0.52–0.89, p = 0.004). There was no association between TyG index and symptomatic intracranial hemorrhage. ‘High TyG’ (defined by TyG index ≥ 9.15) was associated with mortality, poor functional outcomes and no ENI. In conclusion, the TyG index, a measure of insulin resistance, was significantly associated with poorer clinical outcomes in AIS patients who received tPA.

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“…Stroke outcomes have improved in the past decade, caused by the improvements in in-hospital stroke care. According to a big data study from Singapore ( 25 ), there has been a decreasing incidence of AIS in Asia, but the rate of thrombolysis in Asian patients is still much lower than that in developed countries ( 26 , 27 ) (9.5% in China vs. 11.7–18.2% in the USA). Due to poor or low r-tPA reperfusion rate and because patients receiving thrombolytic therapy have a higher ICH rate and consequently worse outcomes compared with the counterparts, it is necessary to identify patients who are more likely to develop sICH after thrombolysis.…”

Section: Discussionmentioning

confidence: 99%

The SON2A2 score: A novel grading scale for predicting hemorrhage and outcomes after thrombolysis

Ren

He²,

Du³

et al. 2022

Front. Neurol.

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ObjectivesThis study aimed to develop a score including novel putative predictors for predicting the risk of sICH and outcomes after thrombolytic therapy with intravenous (IV) recombinant tissue-type plasminogen activator (r-tPA) in acute ischemic stroke patients.MethodsAll patients with acute ischemic stroke treated with IV r-tPA at three university-based hospitals in Chongqing, China, from 2014 to 2019 were retrospectively studied. Potential risk factors associated with sICH (NINDS criteria) were determined with multivariate logistic regression, and we developed our score according to the magnitude of logistic regression coefficients. The score was validated in another independent cohort. Area under the receiver operating characteristic curve (AUC-ROC) was used to assess the performance of the score. Calibration was evaluated using the Hosmer–Lemeshow goodness-of-fit method.ResultsThe SON2A2 score (0 to 8 points) consisted of history of smoking (no = 1, yes = 0, β = 0.81), onset-to-needle time (≥3.5 = 1,<3.5=0, β = 0.74), NIH Stroke Scale on admission (>10 = 2, ≤10 = 0, β = 1.22), neutrophil percentage (≥80.0% = 1, <80% = 0, β = 0.81), ASPECT score (≤11 = 2, >11 = 0, β = 1.30), and age (>65 years = 1, ≤65 years = 0, β = 0.89). The SON2A2 score was strongly associated with sICH (OR 1.98; 95%CI 1.675–2.34) and poor outcomes (OR 1.89; 95%CI 1.68–2.13). AUC-ROC in the derivation cohort was 0.82 (95%CI 0.77–0.86). Similar results were obtained in the validation cohort. The Hosmer–Lemeshow test revealed that predicted and observed event rates in derivation and validation cohorts were very close.ConclusionThe SON2A2 score is a simple, efficient, quick, and easy-to-perform scale for predicting the risk of sICH and outcome after intravenous r-tPA thrombolysis within 4.5 h in patients with ischemic stroke, and risk assessment using this test has the potential for early and personalized management of this disease in high-risk patients.

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Long-Term Trends in Ischemic Stroke Incidence and Risk Factors: Perspectives from an Asian Stroke Registry

Cited by 11 publications

References 9 publications

Temporal Trends in Stroke Management and Outcomes between 2011 and 2020: Results from a Nationwide Multicenter Registry

Temporal Trends in Stroke Management and Outcomes between 2011 and 2020: Results from a Nationwide Multicenter Registry

Association of triglyceride-glucose index with clinical outcomes in patients with acute ischemic stroke receiving intravenous thrombolysis

The SON2A2 score: A novel grading scale for predicting hemorrhage and outcomes after thrombolysis

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