Contemporary Statistics of Acute Ischemic Stroke and Transient Ischemic Attack in 2021: Insights From the CRCS-K-NIH Registry

Abstract

This report presents the latest statistics on the stroke population in South Korea, sourced from the Clinical Research Collaborations for Stroke in Korea-National Institute for Health (CRCS-K-NIH), a comprehensive, nationwide, multicenter stroke registry. The Korean cohort, unlike western populations, shows a male-to-female ratio of 1.5, attributed to lower risk factors in Korean women. The average ages for men and women are 67 and 73 years, respectively. Hypertension is the most common risk factor (67%), consistent with global trends, but there is a higher prevalence of diabetes (35%) and smoking (21%). The prevalence of atrial fibrillation (19%) is lower than in western populations, suggesting effective prevention strategies in the general population. A high incidence of large artery atherosclerosis (38%) is observed, likely due to prevalent intracranial arterial disease in East Asians and advanced imaging techniques. There has been a decrease in intravenous thrombolysis rates, from 12% in 2017-2019 to 10% in 2021, with no improvements in door-to-needle and door-to-puncture times, worsened by the coronavirus disease 2019 pandemic. While the use of aspirin plus clopidogrel for non-cardioembolic stroke and direct oral anticoagulants for atrial fibrillation is well-established, the application of direct oral anticoagulants for non-atrial fibrillation cardioembolic strokes in the acute phase requires further research. The incidence of early neurological deterioration (13%) and the cumulative incidence of recurrent stroke at 3 months (3%) align with global figures. Favorable outcomes at 3 months (63%) are comparable internationally, yet the lack of improvement in dependency at 3 months highlights the need for advancements in acute stroke care.

Keywords: Demography; Hypertension; Ischemic Attack, Transient; Ischemic Stroke; Korea; Statistics; Stroke.

Fig. 1. Participating stroke centers and their geographic locations until 2021.

Fig. 2. Prevalences of vascular risk factors among acute ischemic stroke patients, categorized by country. Prevalence of hypertension (A), diabetes (B), dyslipidemia (C), current smoking (D) and atrial fibrillation (E).

Fig. 3. Proportion of patients with intracranial, extracranial steno-occlusion or without steno-occlusion among those with large artery atherosclerosis stroke.

Fig. 4. NIHSS score at hospital arrival.

NIHSS = National Institute for Health Stroke Scale, AIS = acute ischemic stroke, SD = standard deviation, IQR = interquartile range.

Fig. 5. Proportion of recanalization therapy administered from 2008 to 2021.

IVT = intravenous thrombolysis, EVT = endovascular treatment.

Fig. 6. Door-to-needle and door-to-puncture times from 2008 to 2021. Door-to-needle and door-to-puncture times (A) and the proportion (B) of patients achieving door-to-needle time within 60 minutes and door-to-puncture time within 90 minutes.

Fig. 7. Antithrombotic medications (multiple choices permitted) administered between 2008 and 2021. (A) Acute (within 48 hours of hospitalization) and (B) at-discharge antithrombotic medications.

^aBoth conventional and low-molecular weighted heparin. ^bApixaban, dabigatran, rivaroxaban, edoxaban. ^cOther antiplatelets + other anticoagulants.