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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
One-Year Outcomes After Minor Stroke or High-Risk Transient Ischemic Attack: Korean Multicenter Stroke Registry
Hong-Kyun Park1, Beom Joon Kim1, Moon-Ku Han1
1From the Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (H.-K.P., B.J.K., M.-K.H., H.-J.B.); Department of Neurology, Eulji General Hospital (J.-M.P., K.K.) and Department of Neurology, Eulji University Hospital (S.J.L., J.G.K.), Eulji University, Daejeon, Korea; Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K., H.-W.N.); Department of Neurology, Seoul Medical Center, Korea (T.H.P., S.-S.P.); Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.B.L.); Department of Neurology, Yeungnam University Hospital, Daegu, Korea (J.L.); Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H., Y.-J.C.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.-S.O.); Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K., K.-H.C.); Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.); Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Korea (J.C.C.); Global Medical Affairs, AstraZeneca Gothenburg, Mölndal, Sweden (S.J.); Medical Department, AstraZeneca Korea, Seoul (S.J.L., W.H.L.); Clinical Research Center, ASAN Medical Center, Seoul, Korea (J.S.L.); and Department of Biostatistics, Korea University College of Medicine, Seoul (J.L.).
Background And Purpose:
Patients with minor ischemic stroke or transient ischemic attack are at high risk of recurrent stroke and vascular events, which are potentially disabling or fatal. This study aimed to evaluate contemporary subsequent vascular event risk after minor ischemic stroke or transient ischemic attack in Korea.
Methods:
Patients with minor ischemic stroke or high-risk transient ischemic attack admitted within 7 days of symptom onset were identified from a Korean multicenter stroke registry database. We estimated 3-month and 1-year event rates of the primary outcome (composite of stroke recurrence, myocardial infarction, or all-cause death), stroke recurrence, a major vascular event (composite of stroke recurrence, myocardial infarction, or vascular death), and all-cause death and explored differences in clinical characteristics and event rates according to antithrombotic strategies at discharge.
Results:
Of 9506 patients enrolled in this study, 93.8% underwent angiographic assessment and 72.7% underwent cardiac evaluations; 25.1% had symptomatic stenosis or occlusion of intracranial arteries. At discharge, 95.2% of patients received antithrombotics (antiplatelet polytherapy, 37.1%; anticoagulation, 15.3%) and 86.2% received statins. The 3-month cumulative event rate was 5.9% for the primary outcome, 4.3% for stroke recurrence, 4.6% for a major vascular event, and 2.0% for all-cause death. Corresponding values at 1 year were 9.3%, 6.1%, 6.7%, and 4.1%, respectively. Patients receiving nonaspirin antithrombotic strategies or no antithrombotic agent had higher baseline risk profiles and at least 1.5× higher event rates for clinical event outcomes than those with aspirin monotherapy.
Conclusions:
Contemporary secondary stroke prevention strategies based on thorough diagnostic evaluation may contribute to the low subsequent vascular event rates observed in real-world clinical practice in Korea.
