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

Abstract

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.