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Case characteristics, hyperacute treatment, and outcome information from the clinical research center for stroke-fifth division registry in South Korea.

Kim BJ, Park JM, Kang K, Lee SJ, Ko Y, Kim JG, Cha JK, Kim DH, Nah HW, Han MK, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Cho KH, Kim JT, Choi JC, Kim WJ, Shin DI, Yeo MJ, Sohn SI, Hong JH, Lee J, Lee JS, Yoon BW, Bae HJ - J Stroke (2015)

Bottom Line: 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 above findings will be compared with other Asian and US registry data in this article.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

Temporal trends of selected variables over 5.5 years of the CRCS-5 registry. Temporal trends of recanalization treatments in the CRCS-5 registry over the 6 years (A). The relative proportions of IV thrombolysis (purple bar), endovascular-only recanalization (orange bar) and combined IV-endovascular recanalization (green bar) remained stable during the inclusion period (bar graph). However, the proportion of recanalization-treated cases consistently increased in the registry from 8.8% (231 cases) in 2008 to 14.8% (927 cases) in 2013 (line graph). Temporal trends of onset (last seen normal) to arrival delay over the 6 years in the CRCS-5 registry (B). The proportions of early arrivals within 3 hours of onset steadily increased (bar graph) and the median onset to arrival delay were lowered from 14.8 hours in 2008 to 11.9 hours in 2013 for the entire population of CRCS-5 registry. Temporal trends of vascular risk factors in CRCS-5 registry (C). Overall, the percentages of risk factors did not demonstrate noticeable changes over the recruitment period. Temporal trends of median hospitalization duration over the 6 years, decreasing from 8.4 [5.5-14.4] days in 2008 to 6.7 [4.5-10.7] days in 2013 (D). The upper and lower error bars represent the 75th and 25th percentiles, respectively. OTA, onset-to-arrival.
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Figure 3: Temporal trends of selected variables over 5.5 years of the CRCS-5 registry. Temporal trends of recanalization treatments in the CRCS-5 registry over the 6 years (A). The relative proportions of IV thrombolysis (purple bar), endovascular-only recanalization (orange bar) and combined IV-endovascular recanalization (green bar) remained stable during the inclusion period (bar graph). However, the proportion of recanalization-treated cases consistently increased in the registry from 8.8% (231 cases) in 2008 to 14.8% (927 cases) in 2013 (line graph). Temporal trends of onset (last seen normal) to arrival delay over the 6 years in the CRCS-5 registry (B). The proportions of early arrivals within 3 hours of onset steadily increased (bar graph) and the median onset to arrival delay were lowered from 14.8 hours in 2008 to 11.9 hours in 2013 for the entire population of CRCS-5 registry. Temporal trends of vascular risk factors in CRCS-5 registry (C). Overall, the percentages of risk factors did not demonstrate noticeable changes over the recruitment period. Temporal trends of median hospitalization duration over the 6 years, decreasing from 8.4 [5.5-14.4] days in 2008 to 6.7 [4.5-10.7] days in 2013 (D). The upper and lower error bars represent the 75th and 25th percentiles, respectively. OTA, onset-to-arrival.

Mentions: Over the 6 years, a few interesting trends were noted in the CRCS-5 registry. The proportion of acute recanalization treatment of any sort increased from 8.8% in 2008 to 14.8% in 2013 (P-for-trend over the 6 years <0.01; Figure 3A). Increasing utilization of acute treatment was also detected in the US,13 but the dramatic increase by 6% over 6 years observed here was exceptional. During the 6 years, the proportion of endovascular recanalization treatment with or without preceding IV alteplase remained unchanged at around 30%-37% (P-for-trend, 0.13). Even after the introduction of the Solitaire neurothrombectomy stent device (ev3 Inc., Plymouth, MN, USA) to South Korea in 2011, the proportion did not change. Such improvement in the utilization of alteplase would result from earlier arrival of acute stroke cases. The proportion of stroke cases who arrived within 3 hours of onset was 27% in 2008 (median onset-to-arrival delay of the whole population, 14.8 hours) but elevated to 32% in 2013 (median 11.9 hours; P-for-trend of arrival within 3 hours from onset <0.01; Figure 3B). However, the vascular risk factors showed relatively consistent profiles over the 6 years (Figure 3C), contrasting the increased prevalence and attributable risk from obesity and hypertension observed in the US over the last 10 years.13,14 One interesting finding was that the length of hospital stay has been consistently decreasing in CRCS-5 registry cases (Figure 3D). The duration of hospitalization is usually considered a major source of healthcare costs for stroke patients, and it can be inferred from the trends that economical pressure for cost reduction is growing in the stroke care system in South Korea.15,16,17


Case characteristics, hyperacute treatment, and outcome information from the clinical research center for stroke-fifth division registry in South Korea.

Kim BJ, Park JM, Kang K, Lee SJ, Ko Y, Kim JG, Cha JK, Kim DH, Nah HW, Han MK, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Cho KH, Kim JT, Choi JC, Kim WJ, Shin DI, Yeo MJ, Sohn SI, Hong JH, Lee J, Lee JS, Yoon BW, Bae HJ - J Stroke (2015)

Temporal trends of selected variables over 5.5 years of the CRCS-5 registry. Temporal trends of recanalization treatments in the CRCS-5 registry over the 6 years (A). The relative proportions of IV thrombolysis (purple bar), endovascular-only recanalization (orange bar) and combined IV-endovascular recanalization (green bar) remained stable during the inclusion period (bar graph). However, the proportion of recanalization-treated cases consistently increased in the registry from 8.8% (231 cases) in 2008 to 14.8% (927 cases) in 2013 (line graph). Temporal trends of onset (last seen normal) to arrival delay over the 6 years in the CRCS-5 registry (B). The proportions of early arrivals within 3 hours of onset steadily increased (bar graph) and the median onset to arrival delay were lowered from 14.8 hours in 2008 to 11.9 hours in 2013 for the entire population of CRCS-5 registry. Temporal trends of vascular risk factors in CRCS-5 registry (C). Overall, the percentages of risk factors did not demonstrate noticeable changes over the recruitment period. Temporal trends of median hospitalization duration over the 6 years, decreasing from 8.4 [5.5-14.4] days in 2008 to 6.7 [4.5-10.7] days in 2013 (D). The upper and lower error bars represent the 75th and 25th percentiles, respectively. OTA, onset-to-arrival.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325643&req=5

Figure 3: Temporal trends of selected variables over 5.5 years of the CRCS-5 registry. Temporal trends of recanalization treatments in the CRCS-5 registry over the 6 years (A). The relative proportions of IV thrombolysis (purple bar), endovascular-only recanalization (orange bar) and combined IV-endovascular recanalization (green bar) remained stable during the inclusion period (bar graph). However, the proportion of recanalization-treated cases consistently increased in the registry from 8.8% (231 cases) in 2008 to 14.8% (927 cases) in 2013 (line graph). Temporal trends of onset (last seen normal) to arrival delay over the 6 years in the CRCS-5 registry (B). The proportions of early arrivals within 3 hours of onset steadily increased (bar graph) and the median onset to arrival delay were lowered from 14.8 hours in 2008 to 11.9 hours in 2013 for the entire population of CRCS-5 registry. Temporal trends of vascular risk factors in CRCS-5 registry (C). Overall, the percentages of risk factors did not demonstrate noticeable changes over the recruitment period. Temporal trends of median hospitalization duration over the 6 years, decreasing from 8.4 [5.5-14.4] days in 2008 to 6.7 [4.5-10.7] days in 2013 (D). The upper and lower error bars represent the 75th and 25th percentiles, respectively. OTA, onset-to-arrival.
Mentions: Over the 6 years, a few interesting trends were noted in the CRCS-5 registry. The proportion of acute recanalization treatment of any sort increased from 8.8% in 2008 to 14.8% in 2013 (P-for-trend over the 6 years <0.01; Figure 3A). Increasing utilization of acute treatment was also detected in the US,13 but the dramatic increase by 6% over 6 years observed here was exceptional. During the 6 years, the proportion of endovascular recanalization treatment with or without preceding IV alteplase remained unchanged at around 30%-37% (P-for-trend, 0.13). Even after the introduction of the Solitaire neurothrombectomy stent device (ev3 Inc., Plymouth, MN, USA) to South Korea in 2011, the proportion did not change. Such improvement in the utilization of alteplase would result from earlier arrival of acute stroke cases. The proportion of stroke cases who arrived within 3 hours of onset was 27% in 2008 (median onset-to-arrival delay of the whole population, 14.8 hours) but elevated to 32% in 2013 (median 11.9 hours; P-for-trend of arrival within 3 hours from onset <0.01; Figure 3B). However, the vascular risk factors showed relatively consistent profiles over the 6 years (Figure 3C), contrasting the increased prevalence and attributable risk from obesity and hypertension observed in the US over the last 10 years.13,14 One interesting finding was that the length of hospital stay has been consistently decreasing in CRCS-5 registry cases (Figure 3D). The duration of hospitalization is usually considered a major source of healthcare costs for stroke patients, and it can be inferred from the trends that economical pressure for cost reduction is growing in the stroke care system in South Korea.15,16,17

Bottom Line: 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 above findings will be compared with other Asian and US registry data in this article.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.

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.

No MeSH data available.


Related in: MedlinePlus