The Third China National Stroke Registry (CNSR-III) for patients with acute ischaemic stroke or transient ischaemic attack: design, rationale and baseline patient characteristics

Wang, Yongjun; Jing, Jing; Meng, Xia; Pan, Yuesong; Wang, Yilong; Wang, Wenjuan; Lin, Jinxi; Li, Wei; Jiang, Yong; Li, Zixiao; Zhang, Xinmiao; Yang, Xiaomeng; Ji, Ruijun; Wang, Chunjuan; Wang, Zhimin; Han, Xuan; Wu, Songdi; Jia, Zhengchang; Chen, Yongming; Li, Hao

doi:10.1136/svn-2019-000242

Cited by 183 publications

(202 citation statements)

References 21 publications

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“…CNSR-II recruited 19 604 inpatients ≥18 years of age with acute IS. 4 Between August 2015 and March 2018, CNSR-III recruited consecutive patients with IS or transient ischaemic attack from 201 hospitals that cover 22 provinces and four municipalities in China. A total of 15 166 patients with stroke were enrolled, among whom 93.3% had IS.…”

Section: Data Sourcesmentioning

confidence: 99%

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China Stroke Statistics 2019: A Report From the National Center for Healthcare Quality Management in Neurological Diseases, China National Clinical Research Center for Neurological Diseases, the Chinese Stroke Association, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations

et al. 2020

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China faces the greatest challenge from stroke in the world. The death rate for cerebrovascular diseases in China was 149.49 per 100 000, accounting for 1.57 million deaths in 2018. It ranked third among the leading causes of death behind malignant tumours and heart disease. The age-standardised prevalence and incidence of stroke in 2013 were 1114.8 per 100 000 population and 246.8 per 100 000 person-years, respectively. According to the Global Burden of Disease Study 2017, the years of life lost (YLLs) per 100 000 population for stroke increased by 14.6%; YLLs due to stroke rose from third highest among all causes in 1990 to the highest in 2017. The absolute numbers and rates per 100 000 population for all-age disability-adjusted life years (DALYs) for stroke increased substantially between 1990 and 2017, and stroke was the leading cause of all-age DALYs in 2017. The main contributors to cerebrovascular diseases include behavioural risk factors (smoking and alcohol use) and pre-existing conditions (hypertension, diabetes mellitus, dyslipidaemia and atrial fibrillation (AF)). The most prevalent risk factors among stroke survivors were hypertension (63.0%-84.2%) and smoking (31.7%-47.6%). The least prevalent was AF (2.7%-7.4%). The prevalences for major risk factors for stroke are high and most have increased over time. Based on the latest national epidemiological data, 26.6% of adults aged ≥15 years (307.6 million adults) smoked tobacco products. For those aged ≥18 years, age-adjusted prevalence of hypertension was 25.2%; adjusted prevalence of hypercholesterolaemia was 5.8%; and the standardised prevalence of diabetes was 10.9%. For those aged ≥40 years, the standardised prevalence of AF was 2.31%. Data from the Hospital Quality Monitoring System showed that 3 010 204 inpatients with stroke were admitted to 1853 tertiary care hospitals during 2018. Of those, 2 466 785 (81.9%) were ischaemic strokes (ISs); 447 609 (14.9%) were intracerebral haemorrhages (ICHs); and 95 810 (3.2%) were subarachnoid haemorrhages (SAHs). The average age of patients admitted was 66 years old, and nearly 60% were male. A total of 1555 (0.1%), 2774 (0.6%) and 1347 (1.4%) paediatric strokes (age <18 years) were identified among IS, ICH and SAH, respectively. Over one-third (1 063 892 (35.3%)) of the patients were covered by urban resident basic medical insurance, followed by urban employee basic medical insurance (699 513 (23.2%)) and new rural cooperative medical schema (489 361 (16.3%)). The leading risk factor was hypertension (67.4% for IS, 77.2% for ICH and 49.1% for SAH), and the leading comorbidity was pneumonia or pulmonary infection (10.1% for IS, 31.4% for ICH and 25.2% for SAH). In-hospital death/discharge against medical advice rate was 8.3% for stroke inpatients, ranging from 5.8% for IS to 19.5% for ICH. The median and IQR of length of stay was 10.0 (7.0–14.0) days, ranging from 10.0 (7.0–13.0) in IS to 14.0 (8.0–22.0) in SAH. Data from the Chinese Stroke Center Alliance demonstrated that the composite scores of guideline-recommended key performance indicators for patients with IS, ICH and SAH were 0.77±0.21, 0.72±0.28 and 0.59±0.32, respectively.

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Section: Data Sourcesmentioning

confidence: 99%

“…In the past decades, several registry studies have been launched, including the China National Stroke Registries (CNSR-I, CNSR-II and CNSR-III). [3][4][5] These registries provide timely evidence for clinical practice and scientific research.…”

Section: Introductionmentioning

confidence: 99%

China Stroke Statistics 2019: A Report From the National Center for Healthcare Quality Management in Neurological Diseases, China National Clinical Research Center for Neurological Diseases, the Chinese Stroke Association, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations

et al. 2020

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“…ICONS is one of the research subgroups of China National Stroke Registry-III (CNSR-III). 10 CNSR-III is a nationwide prospective registry for consecutive patients presented to hospitals within 7 days after AIS or transient ischemic attack (TIA) between August 2015 and March 2018 in China. The protocol of the CNSR-III study was approved by ethics committee at Beijing Tiantan Hospital.…”

Section: Overview Of the Studymentioning

confidence: 99%

“…The ICONS study baseline data and follow-up collection and processing methods were the same as the CNSR-III study. 10 Patients were interviewed face-to-face at 2w, 3m and 12m and contacted over the telephone by trained research coordinators at 6m and 2-5 years annually. Based on the follow-up content of CNSR-III study.…”

Section: Baseline/follow-up Data Collection and Data Managementmentioning

confidence: 99%

<p>The Occurrence and Longitudinal Changes of Cognitive Impairment After Acute Ischemic Stroke</p>

Liao¹,

Zuo²,

Zhang³

et al. 2020

NDT

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“…The patients were interviewed face to face at 90 days and contacted by telephone at 1 year after enrollment by a trained research coordinator in CNSR- [19]. Information regarding any end point event, and the functional status was collected at each follow-up interview.…”

Section: Patient Follow-up and Outcome Assessmentmentioning

confidence: 99%

Fibrinogen Level Predicts Prognosis of Patients with Acute Ischemic Stroke or TIA

Hou¹,

Xiang²,

Pan³

et al. 2020

Preprint

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Background: Fibrinogen is involved in acute stroke. This study aimed to investigate the association between fibrinogen and prognosis in patients with acute ischemic stroke or transient ischemic attack (TIA). Methods: Using data from the CNSR-Ⅲ (Third China National Stroke Registry), this sub-study included 10 518 (69%) consecutive patients who had fibrinogen levels measured. The primary outcome was a poor functional outcome defined as modified Rankin Scale score of 3 to 6 within 90 days. The secondary outcomes were stroke recurrence, ischemic stroke recurrence, composite vascular events, and poor functional outcome during the 1-year follow-up and a new vascular event at 90 days. Multivariate logistic regression and Cox regression analyses were used to assess the associations between fibrinogen and prognosis of patients. Results: In total, 1446 (13.9%) patients had a poor functional outcome at 90 days. High fibrinogen levels were associated with poor functional outcome (adjusted odds ratio [OR], 1.35; 95% confidence interval [CI], 1.12-1.64) at 90 days after adjustment for confounding risk factors. High fibrinogen levels also independently predicted poor functional outcome during the 1-year follow-up. Stroke recurrence occurred in 657 (6.3%) patients at 90 days. High fibrinogen levels were associated with stroke recurrence, ischemic stroke recurrence, and composite vascular events in the crude model, but further adjustment eliminated these associations in the multivariate models. Conclusion: Our study showed that high fibrinogen level was independently associated with poor functional outcome but not with stroke recurrence in patients with acute ischemic stroke or TIA.

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The Third China National Stroke Registry (CNSR-III) for patients with acute ischaemic stroke or transient ischaemic attack: design, rationale and baseline patient characteristics

Cited by 183 publications

References 21 publications

<p>The Occurrence and Longitudinal Changes of Cognitive Impairment After Acute Ischemic Stroke</p>

Fibrinogen Level Predicts Prognosis of Patients with Acute Ischemic Stroke or TIA

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