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1.
Journal of Stroke ; : 113-123, 2021.
Article in English | WPRIM | ID: wpr-874951

ABSTRACT

Background@#and Purpose To evaluate the outcome events and bleeding complications of the European Society of Cardiology (ESC) guideline-matched oral anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation (AF). @*Methods@#Patients with acute ischemic stroke and AF from a nationwide multicenter registry (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts [K-ATTENTION]) between January 2013 and December 2015 were included in the study. Patients were divided into the ESC guideline-matched and the non-matched groups. The primary outcome was recurrence of any stroke during the 90-day follow-up period. Secondary outcomes were major adverse cerebrovascular and cardiovascular events, ischemic stroke, intracranial hemorrhage, acute coronary syndrome, allcause mortality, and major hemorrhage. Propensity score matching and logistic regression analyses were performed to assess the effect of the treatments administered. @*Results@#Among 2,321 eligible patients, 1,126 patients were 1:1 matched to the ESC guidelinematched and the non-matched groups. As compared with the non-matched group, the ESC guideline-matched group had a lower risk of any recurrent stroke (1.4% vs. 3.4%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18 to 0.95). The risk of recurrent ischemic stroke was lower in the ESC guideline-matched group than in the non-matched group (0.9% vs. 2.7%; OR, 0.32; 95% CI, 0.11 to 0.88). There was no significant difference in the other secondary outcomes between the two groups. @*Conclusions@#ESC guideline-matched oral anticoagulant therapy was associated with reduced risks of any stroke and ischemic stroke as compared with the non-matched therapy.

2.
Article in English | WPRIM | ID: wpr-765071

ABSTRACT

BACKGROUND: Using data from a large national stroke registry, we aimed to investigate the incidence and determinants of in-hospital and post-discharge recovery after acute ischemic stroke and the independence of their occurrence. METHODS: In-hospital recovery was defined as an improvement of 4 points or > 40% in the National Institutes of Health Stroke Scale (NIHSS) score from admission to discharge. Post-discharge recovery was defined as any improvement in the modified Rankin Scale (mRS) score from discharge to 3 months after stroke onset. Two analytic methods (multivariate and multivariable logistic regression) were applied to compare the effects of 18 known determinants of 3-month outcome and to verify whether in-hospital and post-discharge recovery occur independently. RESULTS: During 54 months, 11,088 patients with acute ischemic stroke meeting the eligibility criteria were identified. In-hospital and post-discharge recovery occurred in 36% and 33% of patients, respectively. Multivariate logistic regression with an equality test for odds ratios showed that 7 determinants (age, onset-to-admission time, NIHSS score at admission, blood glucose at admission, systolic blood pressure, smoking, recanalization therapy) had a differential effect on in-hospital and post-discharge recovery in the way of the opposite direction or of the same direction with different degree (all P values < 0.05). Both in-hospital and post-discharge recovery occurred in 12% of the study population and neither of them in 43%. The incidence of post-discharge recovery in those with in-hospital recovery was similar to that in those without (33.8% vs. 32.7%, respectively), but multivariable analysis showed that these 2 types of recovery occurred independently. CONCLUSION: Our findings suggest that, in patients with acute ischemic stroke, in-hospital and post-discharge recovery may occur independently and largely in response to different factors.


Subject(s)
Blood Glucose , Blood Pressure , Humans , Incidence , Logistic Models , Odds Ratio , Prognosis , Registries , Smoke , Smoking , Stroke
3.
Article in English | WPRIM | ID: wpr-764993

ABSTRACT

BACKGROUND: Patients who survive an acute phase of stroke are at risk of falls and fractures afterwards. However, it is largely unknown how frequent fractures occur in the Asian stroke population. METHODS: Patients with acute (< 7 days) ischemic stroke who were hospitalized between January 2011 and November 2013 were identified from a prospective multicenter stroke registry in Korea, and were linked to the National Health Insurance Service claim database. The incidences of fractures were investigated during the first 4 years after index stroke. The cumulative incidence functions (CIFs) were estimated by the Gray's test for competing risk data. Fine and Gray model for competing risk data was applied for exploring risk factors of post-stroke fractures. RESULTS: Among a total of 11,522 patients, 1,616 fracture events were identified: 712 spine fractures, 397 hip fractures and 714 other fractures. The CIFs of any fractures were 2.63% at 6 months, 4.43% at 1 year, 8.09% at 2 years and 13.00% at 4 years. Those of spine/hip fractures were 1.11%/0.61%, 1.88%/1.03%, 3.28%/1.86% and 5.79%/3.15%, respectively. Age by a 10-year increment (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.17–1.30), women (HR, 1.74; 95% CI, 1.54–1.97), previous fracture (HR, 1.72; 95% CI, 1.54–1.92) and osteoporosis (HR, 1.44; 95% CI, 1.27–1.63) were independent risk factors of post-stroke fracture. CONCLUSION: The CIFs of fractures are about 8% at 2 years and 13% at 4 years after acute ischemic stroke in Korea. Older age, women, pre-stroke fracture and osteoporosis raised the risk of post-stroke fractures.


Subject(s)
Accidental Falls , Asian Continental Ancestry Group , Epidemiology , Female , Hip Fractures , Humans , Incidence , Korea , National Health Programs , Osteoporosis , Prospective Studies , Risk Factors , Spine , Stroke
4.
Journal of Stroke ; : 42-59, 2019.
Article in English | WPRIM | ID: wpr-740619

ABSTRACT

Despite the great socioeconomic burden of stroke, there have been few reports of stroke statistics in Korea. In this scenario, the Epidemiologic Research Council of the Korean Stroke Society launched the “Stroke Statistics in Korea” project, aimed at writing a contemporary, comprehensive, and representative report on stroke epidemiology in Korea. This report contains general statistics of stroke, prevalence of behavioral and vascular risk factors, stroke characteristics, pre-hospital system of care, hospital management, quality of stroke care, and outcomes. In this report, we analyzed the most up-to-date and nationally representative databases, rather than performing a systematic review of existing evidence. In summary, one in 40 adults are patients with stroke and 232 subjects per 100,000 experience a stroke event every year. Among the 100 patients with stroke in 2014, 76 had ischemic stroke, 15 had intracerebral hemorrhage, and nine had subarachnoid hemorrhage. Stroke mortality is gradually declining, but it remains as high as 30 deaths per 100,000 individuals, with regional disparities. As for stroke risk factors, the prevalence of smoking is decreasing in men but not in women, and the prevalence of alcohol drinking is increasing in women but not in men. Population-attributable risk factors vary with age. Smoking plays a role in young-aged individuals, hypertension and diabetes in middle-aged individuals, and atrial fibrillation in the elderly. About four out of 10 hospitalized patients with stroke are visiting an emergency room within 3 hours of symptom onset, and only half use an ambulance. Regarding acute management, the proportion of patients with ischemic stroke receiving intravenous thrombolysis and endovascular treatment was 10.7% and 3.6%, respectively. Decompressive surgery was performed in 1.4% of patients with ischemic stroke and in 28.1% of those with intracerebral hemorrhage. The cumulative incidence of bleeding and fracture at 1 year after stroke was 8.9% and 4.7%, respectively. The direct costs of stroke were about ₩1.68 trillion (KRW), of which ₩1.11 trillion were for ischemic stroke and ₩540 billion for hemorrhagic stroke. The great burden of stroke in Korea can be reduced through more concentrated efforts to control major attributable risk factors for age and sex, reorganize emergency medical service systems to give patients with stroke more opportunities for reperfusion therapy, disseminate stroke unit care, and reduce regional disparities. We hope that this report can contribute to achieving these tasks.


Subject(s)
Adult , Aged , Alcohol Drinking , Ambulances , Atrial Fibrillation , Cerebral Hemorrhage , Emergency Medical Services , Emergency Service, Hospital , Epidemiology , Female , Hemorrhage , Hope , Humans , Hypertension , Incidence , Korea , Male , Mortality , Prevalence , Reperfusion , Risk Factors , Smoke , Smoking , Stroke , Subarachnoid Hemorrhage , Writing
5.
Journal of Stroke ; : 69-77, 2019.
Article in English | WPRIM | ID: wpr-740617

ABSTRACT

BACKGROUND AND PURPOSE: Thrombectomy within 24 hours can improve outcomes in selected patients with a clinical-infarct mismatch. We devised an easy-to-use visual estimation tool that allows infarct volume estimation in centers with limited resources. METHODS: We identified 1,031 patients with cardioembolic or large-artery atherosclerosis infarction on diffusion-weighted images (DWIs) obtained before recanalization therapy and within 24 hours of onset, and occlusion of the internal carotid or middle cerebral artery. Acute DWIs were mapped onto a standard template and used to create visual reference maps with known lesion volumes, which were then used in a validation study (with 130 cases) against software estimates of infarct volume. RESULTS: The DWI reference map chart comprises 144 maps corresponding to 12 different infarct volumes (0.5, 1, 2, 3, 5, 7, 9, 11, 13, 15, 17, and 19 mL) in each of 12 template slices (Montreal Neurological Institute z-axis –15 to 51 mm). Infarct volume in a patient is estimated by selecting a slice with a similar infarct size at the corresponding z-axis level on the reference maps and then adding up over all slices. The method yielded good correlations to software volumetrics and was easily learned by both experienced and junior physicians, with approximately 1 to 2 minutes spent per case. The sensitivity, specificity, and accuracy for detecting threshold infarct volumes ( 90%). CONCLUSIONS: We developed easy-to-use reference maps that allow prompt and reliable visual estimation of infarct volumes for triaging patients to thrombectomy in acute stroke.


Subject(s)
Atherosclerosis , Cerebral Infarction , Decision Making , Diffusion Magnetic Resonance Imaging , Humans , Infarction , Medical Staff, Hospital , Methods , Middle Cerebral Artery , Sensitivity and Specificity , Stroke , Thrombectomy
6.
Psychiatry Investigation ; : 919-925, 2019.
Article in English | WPRIM | ID: wpr-786551

ABSTRACT

OBJECTIVE: Anxiety is one of the most common complications in patients with stroke, but studies on its relationship to functional outcomes are limited and controversial. We investigated the association between post-stroke anxiety (PSA) and a 1-year trajectory of functional outcome.METHODS: A total of 423 patients were recruited within 2 weeks after a stroke (acute phase) during hospitalization. Of them, 306 (72.3%) completed follow-up examinations 1 year thereafter (chronic phase). Anxiety was evaluated using the Hospital Anxiety and Depression Scale-Anxiety subscale, and functional outcomes were measured using the National Institutes of Health Stroke Scale for stroke severity, the Barthel Index for activities of daily living (ADL), and the Mini-Mental State Examination for cognitive function at 2 weeks and 1 year. A range of demographic and clinical covariates were considered. The cross-sectional and longitudinal associations between PSA and functional outcomes were investigated.RESULTS: PSA at the acute phase was not associated with functional outcomes at the cross-sectional point, but predicted worsening of outcome on stroke severity and ADL 1 year after stroke. PSA at the chronic phase was cross-sectionally associated with poor functional outcomes in all three measures. All associations were independent of potential covariates.CONCLUSION: Screening for anxiety is recommended even during the acute phase of stroke, considering its independent detrimental effect on functional prognosis. Screening for anxiety during the chronic phase is also encouraged, as this may reflect the functional status of stroke.


Subject(s)
Activities of Daily Living , Anxiety , Cognition , Depression , Follow-Up Studies , Hospitalization , Humans , Longitudinal Studies , Mass Screening , Prognosis , Stroke
7.
Article in English | WPRIM | ID: wpr-764361

ABSTRACT

BACKGROUND AND PURPOSE: The clinical implications of echocardiography findings for long-term outcomes in atrial fibrillation (AF)-related stroke patients are unknown. METHODS: This was a substudy of the Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION), which is a multicenter-based cohort comprising prospective stroke registries from 11 tertiary centers. Stroke survivors who underwent two-dimensional transthoracic echocardiography during hospitalization were enrolled. Echocardiography markers included the left-ventricle (LV) ejection fraction (LVEF), the left atrium diameter, and the ratio of the peak transmitral filling velocity to the mean mitral annular velocity during early diastole (E/e′ ratio). LVEF was categorized into normal (≥55%), mildly decreased (>40% and <55%), and severely decreased (≤40%). The E/e′ ratio associated with the LV filling pressure was categorized into normal (<8), borderline (≥8 and <15), and elevated (≥15). Kaplan-Meier and Cox regression analyses were performed for recurrent stroke, major adverse cardiac events, and all-cause death. RESULTS: This study finally included 1,947 patients. Over a median follow-up of 1.65 years (interquartile range, 0.42–2.87 years), the rates of recurrent stroke, major adverse cardiac events, and all-cause death were 35.1, 10.8, and 69.6 cases per 1,000 person-years, respectively. Multivariable analyses demonstrated that severely decreased LVEF was associated with a higher risks of major adverse cardiac events [hazard ratio (HR), 3.91; 95% confidence interval (CI), 1.58–9.69] and all-cause death (HR, 1.95; 95% CI, 1.23–3.10). The multivariable fractional polynomial plot indicated that recurrent stroke might be associated with a lower LVEF. CONCLUSIONS: Severe LV systolic dysfunction could be a determinant of long-term outcomes in AF-related stroke.


Subject(s)
Atrial Fibrillation , Cohort Studies , Diastole , Echocardiography , Follow-Up Studies , Heart Atria , Hospitalization , Humans , Prospective Studies , Registries , Stroke , Survivors
9.
Article in Korean | WPRIM | ID: wpr-717847

ABSTRACT

OBJECTIVE: This study aimed to investigate the prevalence and predictors of poststroke anxiety (PSA) at acute and chronic stage. METHODS: PSA was defined as 7 or higher score on Hospital Anxiety and Depression Scale-anxiety subscale within 2 weeks (n=286) and at 1 year (n=222) after the index stroke. Following variables were examined at baseline: sociodemographic characteristics (age, sex, education years, marital status, living alone, and unemployment), risk factor of vascular disease, stroke location on brain imaging, severity of stroke (National Institute of Health Stroke Scale), physical impairment (Barthel Index), etc. These variables were compared by PSA initially using t-test or χ2 test. Those variables shown significant associations (p < 0.05) entered simultaneously to logistic regression analysis for evaluating independent predictive factors. RESULTS: PSA was observed in 27 patients (9.4%) at acute stage, and in 35 patients (15.8%) at chronic stage. Acute PSA was associated with younger age and higher Hamilton Depression Rating Scale (HAM-D) score, and chronic PSA was associated with hypertension and higher HAM-D score. CONCLUSION: PSA was prevalent and was associated with those variables on poor prognosis of stroke outcome. Therefore, early screening of PSA and referral to proper treatment may reduce stroke burden.


Subject(s)
Anxiety , Depression , Education , Epidemiology , Humans , Hypertension , Logistic Models , Marital Status , Mass Screening , Neuroimaging , Prevalence , Prognosis , Referral and Consultation , Risk Factors , Stroke , Vascular Diseases
10.
Article in Korean | WPRIM | ID: wpr-766685

ABSTRACT

Korea is one of the fastest aging country in the world. As the old population increases, incidence of stroke would rapidly increase. We estimated future of the neurologist supply in Korea, and assessed whether the present neurologist supply is appropriate to cope with future increase of stroke. We reviewed the resource database of neurologists affiliated to Korean Neurological Association. Age, sex, location of workplace, and work positions were identified. The stroke incidence was calculated from age group specific incidence data and projected age group number. Age group specific incidence data was adapted from the 2006 report of the Construction of National Surveillance System for Cardiovascular and Cerebrovascular Disease. Total 1,828 neurologists in practice were identified. Six hundred and fifty-five (30%) worked in training hospitals. 457 (21%) in other general hospitals, 305 (14%) in private clinics, and 148 (7%) worked in nursing hospitals. Assuming that the neurologists are trained 82 people per year as in the present, 2,073 neurologists would be present in 2020, 2,659 in 2030. However, stroke incidence would show more rapid increment, and is expected about 170,000 per year in 2020 and 300,000 per year in 2030. Therefore, there will be a shortage of neurologists needed for stroke care in the future. Because of rapid increase in the elderly population, current supply of neurologists may not meet the expected need for stroke care. Therefore, national health system needs more neurologists to cope with that situation.


Subject(s)
Aged , Aging , Cerebrovascular Disorders , Delivery of Health Care , Hospitals, General , Humans , Incidence , Korea , Nursing , Stroke
11.
Psychiatry Investigation ; : 141-146, 2018.
Article in English | WPRIM | ID: wpr-741905

ABSTRACT

OBJECTIVE: Stroke is associated with significant long-term morbidity and poor quality of life (QOL). Depression is one of the most common complications after stroke and has been associated with QOL cross-sectionally. We investigated the longitudinal impact of depression in the acute phase of stroke on QOL 1 year after stroke. METHODS: In total, 423 patients were evaluated 2 weeks after stroke, and 288 (68%) were followed 1 year later. QOL was assessed using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF) at baseline and follow-up. Depression was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria; demographic and clinical characteristics data, including stroke severity, were obtained at baseline. The longitudinal associations of post-stroke depression (PSD) at baseline with QOL across two evaluation points were assessed using a repeated-measures analysis of variance. RESULTS: The WHOQOL-BREF scores were significantly and persistently lower 1 year after stroke in patients with PSD at baseline compared with those without PSD at baseline independent of demographic and clinical characteristics, including stroke severity. CONCLUSION: PSD in the acute phase of stroke is an independent predictor of QOL in both the acute and chronic phases of stroke. Our findings underscore the importance of evaluating depression in the acute phase of stroke.


Subject(s)
Depression , Follow-Up Studies , Humans , Longitudinal Studies , Quality of Life , Stroke , World Health Organization
13.
Annals of Dermatology ; : 283-287, 2017.
Article in English | WPRIM | ID: wpr-45442

ABSTRACT

BACKGROUND: Herpes zoster (HZ) is caused by reactivation of latent varicella-zoster virus (VZV) infection. HZ-associated aseptic meningitis, a rare complication of HZ, can require hospitalization and a long treatment period. OBJECTIVE: A retrospective study was performed to identify potential factors associated with HZ-associated aseptic meningitis development. METHODS: We included all outpatients and patients admitted in the neurology and dermatology departments of a single tertiary center, who were diagnosed with HZ for two years. Among 818 patients, 578 patients were eligible for analysis. RESULTS: The demographics and potential risk factors were compared between the uncomplicated HZ group (n=554) and aseptic meningitis group (n=24). Among the potential factors, the dermatological distribution of skin rash and gender showed statistically significantly different between the two groups. Patients with craniocervical distribution of HZ accounted for 87.5% (n=21) of the aseptic meningitis group and 54.3% (n=301) of the uncomplicated HZ group (p=0.043). The aseptic meningitis group had more men (66.7%, n=16) than the uncomplicated HZ group (42.8%, n=237, p=0.033). Patients with craniocervical distribution had an odds ratio (OR) of 5.884 (p=0.001) for developing aseptic meningitis when compared with the other dermatome involvements. Additional logistic regression analysis resulted in a fading between gender difference (p=0.050) and craniocervical involvement having an OR of 5.667 for aseptic meningitis (p=0.006). CONCLUSION: In HZ patients, skin rash with craniocervical distribution and male gender were associated with a higher risk of aseptic meningitis.


Subject(s)
Demography , Dermatology , Exanthema , Herpes Zoster , Herpesvirus 3, Human , Hospitalization , Humans , Logistic Models , Male , Meningitis , Meningitis, Aseptic , Neurology , Odds Ratio , Outpatients , Retrospective Studies , Risk Factors
15.
Neurology Asia ; : 349-356, 2016.
Article in English | WPRIM | ID: wpr-625553

ABSTRACT

Inflammation might be associated with cognitive impairment and be involved in the pathogenesis of Parkinson’s disease (PD). High-sensitivity C-reactive protein (hs-CRP) is a sensitive biomarker of systemic inflammation. This study aimed to investigate whether serum concentrations of hs-CRP are related to cognitive function in patients with PD. Patients with PD (n = 113, Hoehn and Yahr [H-Y] stage 1-4) underwent evaluation of serum hs-CRP and comprehensive neuropsychological tests that covered the cognitive domains of attention, language, visuospatial function, memory, and executive functions. We categorized subjects with PD as having normal cognition (n=48), mild cognitive impairment (MCI) (n=41), or dementia (n=24). Patients with dementia had a higher hs-CRP level than patients with MCI or normal cognition (2.76 ± 2.53 vs. 1.27 ± 1.99 vs. 0.73 ± 0.88 mg/L, P=0.001). Serum hs-CRP levels were inversely associated with the Mini-Mental State Examination scores and performance on neuropsychological tests of language, visuospatial function, visual memory, and executive function. After controlling for age, sex, symptom duration, education, H-Y stage, and Unified Parkinson’s Disease Rating Scale motor score, multiple regression analyses indicated statistically significant associations between hs-CRP levels and performance on neuropsychological tests of visuospatial function, visual memory, and executive function. This study suggests a possible relationship between serum hs-CRP levels and cognitive function in patients with PD, with higher levels of hs-CRP being associated with poor performance on tests of visuospatial function, visual memory, and executive function.


Subject(s)
Dementia
16.
Neurology Asia ; : 195-197, 2016.
Article in English | WPRIM | ID: wpr-625254

ABSTRACT

Cerebral air embolism is an uncommon disorder, but it can result in significant morbidity and even mortality. Cerebral air embolism during esophago-gastro-duodenoscopy is also rare, but has in recent years been repeatedly reported. We report here a patient with cerebral infarction due to air embolism during endoscopic variceal ligation in liver cirrhosis. The patient was later confirmed to have patent foramen ovale. To our knowledge, this is the first report of such a complication with underlying patent foramen ovale and portal hypertension, who did no have underlying malignancy

17.
Journal of Stroke ; : 344-351, 2016.
Article in English | WPRIM | ID: wpr-9523

ABSTRACT

BACKGROUND AND PURPOSE: About 30%-40% of stroke patients are taking antiplatelet at the time of their strokes, which might increase the risk of symptomatic intracranial hemorrhage (SICH) with intravenous tissue plasminogen activator (IV-TPA) therapy. We aimed to assess the effect of prestroke antiplatelet on the SICH risk and functional outcome in Koreans treated with IV-TPA. METHODS: From a prospective stroke registry, we identified patients treated with IV-TPA between October 2009 and November 2014. Prestroke antiplatelet use was defined as taking antiplatelet within 7 days before the stroke onset. The primary outcome was SICH. Secondary outcomes were discharge modified Rankin Scale (mRS) score and in-hospital mortality. RESULTS: Of 1,715 patients treated with IV-TPA, 441 (25.7%) were on prestroke antiplatelet. Prestroke antiplatelet users versus non-users were more likely to be older, to have multiple vascular risk factors. Prestroke antiplatelet use was associated with an increased risk of SICH (5.9% vs. 3.0%; adjusted odds ratio [OR] 1.79 [1.05-3.04]). However, at discharge, the two groups did not differ in mRS distribution (adjusted OR 0.90 [0.72-1.14]), mRS 0-1 outcome (34.2% vs. 33.7%; adjusted OR 1.27 [0.94-1.72), mRS 0-2 outcome (52.4% vs. 52.9%; adjusted OR 1.21 [0.90-1.63]), and in-hospital mortality (6.1% vs. 4.2%; adjusted OR 1.19 [0.71-2.01]). CONCLUSIONS: Despite an increased risk of SICH, prestroke antiplatelet users compared to non-users had comparable functional outcomes and in-hospital mortality with IV-TPA therapy. Our results support the use of IV-TPA in eligible patients taking antiplatelet therapy before their stroke onset.


Subject(s)
Hospital Mortality , Humans , Intracranial Hemorrhages , Odds Ratio , Platelet Aggregation Inhibitors , Prospective Studies , Risk Factors , Stroke , Thrombolytic Therapy , Tissue Plasminogen Activator
19.
Journal of Stroke ; : 38-53, 2015.
Article in English | WPRIM | ID: wpr-166388

ABSTRACT

Characteristics of stroke cases, acute stroke care, and outcomes after stroke differ according to geographical and cultural background. To provide epidemiological and clinical data on stroke care in South Korea, we analyzed a prospective multicenter clinical stroke registry, the Clinical Research Center for Stroke-Fifth Division (CRCS-5). Patients were 58% male with a mean age of 67.2+/-12.9 years and median National Institutes of Health Stroke Scale score of 3 [1-8] points. Over the 6 years of operation, temporal trends were documented including increasing utilization of recanalization treatment with shorter onset-to-arrival delay and decremental length of stay. Acute recanalization treatment was performed in 12.7% of cases with endovascular treatment utilized in 36%, but the proportion of endovascular recanalization varied across centers. Door-to-IV alteplase delay had a median of 45 [33-68] min. The rate of symptomatic hemorrhagic transformation (HT) was 7%, and that of any HT was 27% among recanalization-treated cases. Early neurological deterioration occurred in 15% of cases and were associated with longer length of stay and poorer 3-month outcomes. The proportion of mRS scores of 0-1 was 42% on discharge, 50% at 3 months, and 55% at 1 year after the index stroke. Recurrent stroke up to 1 year occurred in 4.5% of patients; the rate was higher among older individuals and those with neurologically severe deficits. The above findings will be compared with other Asian and US registry data in this article.


Subject(s)
Asian Continental Ancestry Group , Humans , Korea , Length of Stay , Male , Stroke , Tissue Plasminogen Activator
20.
Journal of Stroke ; : 327-335, 2015.
Article in English | WPRIM | ID: wpr-33652

ABSTRACT

BACKGROUND AND PURPOSE: In a recent pooled analysis of randomized clinical trials (RCTs), intravenous tissue plasminogen activator (TPA) improves the outcome in patients aged > or =80 years. However, it is uncertain whether the findings are applicable to clinical practice in Asian populations. METHODS: From a multicenter stroke registry database of Korea, we identified patients with acute ischemic stroke who were aged > or = 80 years. Using multivariable analysis and propensity score (PS)-matched analyses, we assessed the effectiveness and safety of intravenous TPA within 4.5 hours. RESULTS: Among 2,334 patients who met the eligible criteria, 236 were treated with intravenous TPA (mean age, 83+/-5; median NIHSS, 13 [IQR, 8-17]). At discharge, the TPA group compared to the no-TPA group had a favorable shift on the modified Rankin Scale (mRS) score (multivariable analysis, OR [95% CI], 1.51 [1.17-1.96], P=0.002; PS-matched analysis, 1.54 [1.17-2.04], P=0.002) and was more likely to achieve mRS 0-1 outcome (multivariable analysis, 2.00 [1.32-3.03], P=0.001; PS-matched analysis, 1.59 [1.04-2.42], P=0.032). TPA treatment was associated with an increased risk of symptomatic intracranial hemorrhage (multivariable analysis, 5.45 [2.80-10.59], P<0.001; PS-matched analysis, 4.52 [2.24-9.13], P<0.001), but did not increase the in-hospital mortality (multivariable analysis, 0.86 [0.50-1.48], P=0.58; PS-matched analysis, 0.88 [0.52-1.47], P=0.61). CONCLUSIONS: In the setting of clinical practice, intravenous TPA within 4.5 hours improved the functional outcome despite an increased risk of symptomatic intracranial hemorrhage in very elderly Korean patients. The findings, consistent with those from pooled analysis of RCTs, strongly support the use of TPA for this population.


Subject(s)
Aged , Asian Continental Ancestry Group , Hospital Mortality , Humans , Intracranial Hemorrhages , Korea , Propensity Score , Stroke , Thrombolytic Therapy , Tissue Plasminogen Activator
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