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

Keywords: Case profile; Hyperacute treatment; Outcome; Recurrent event; South Korea; Stroke registry; Thrombolysis.

Figure 1

CRCS-5 centers and their locations.

Figure 2

Timeline of the CRCS-5 registry. DB, database. QI, quality indicator.

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.

Figure 4

Hospital variability in hyperacute treatment modality.

Figure 5

mRS score at 3 months according to early neurological deterioration occurrence. END, early neurological deterioration.

Figure 6

Distribution of mRS score at discharge, 3 months, and 1 year after stroke.

Figure 7

Failure curves for recurrent stroke events (A) and composite outcomes (B) after the index stroke.