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Updated: Sep 19, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Integrated Care Using the ABCstroke Pathway Improves Cardiovascular Outcomes and Survival in Patients with First-Ever
Christopher T W Tsang1, Sylvia E Choi2,3, Tommaso Bucci2,3,4
1Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China.
Insights
Adhering to the ABCstroke pathway in ischemic stroke patients significantly reduced the risk of recurrent stroke, cardiovascular events, and mortality. Optimal management improved cardiovascular outcomes and reduced overall mortality in this patient cohort.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- The European Society of Cardiology Council on Stroke proposed the integrated ABCstroke pathway for optimizing post-stroke management.
- This study evaluates the impact of adherence to this pathway on cardiovascular outcomes in ischemic stroke patients.
Purpose of the Study:
- To assess the association between physicians' adherence to the ABCstroke pathway and cardiovascular outcomes.
- To determine if optimal management following the ABCstroke pathway reduces adverse events after ischemic stroke.
Main Methods:
- Retrospective cohort study of first-ever ischemic stroke patients in Hong Kong (2006-2022).
- Multivariable Cox regression analysis was used to evaluate the association between ABCstroke pathway adherence and a composite primary outcome.
- The primary outcome included recurrent ischemic stroke, transient ischemic attack, hemorrhagic stroke, myocardial infarction, heart failure, and all-cause mortality.
Main Results:
- 58.1% of 9,669 ischemic stroke patients received optimal management per the ABCstroke pathway.
- Adherence to the ABCstroke pathway was associated with a 20% lower risk of the composite endpoint (HR: 0.80; 95% CI: 0.72-0.88).
- Significant risk reductions were observed for hemorrhagic stroke, heart failure, cardiovascular death, and all-cause mortality with pathway adherence.
Conclusions:
- Optimal management according to the ABCstroke pathway in Asian patients with first-ever ischemic stroke is linked to reduced adverse cardiovascular outcomes.
- Progressive risk reduction was noted with increasing adherence to ABCstroke criteria.
- No significant interactions were found based on age, sex, or stroke severity.
Background:
A recent position paper of the European Society of Cardiology Council on Stroke proposed an integrated ABCstroke pathway to optimise post-stroke management. We evaluated the impact of ABCstroke pathway adherence on post-stroke cardiovascular outcomes.
Methods:
Patients with first-ever ischaemic stroke in Hong Kong between 2006 and 2022 were included in this retrospective cohort study. Multivariable Cox regression analysis was performed to evaluate the association between physicians' adherence to the ABCstroke pathway and the primary outcome, which was a composite of recurrent ischaemic stroke, transient ischaemic attack, haemorrhagic stroke, myocardial infarction, heart failure and all-cause mortality.
Results:
Of the 9,669 included patients with ischaemic stroke (mean age 69.6 ± 13.4 years; 57.5% male), 58.1% were optimally managed according to all three ABCstroke pillars. After 1 year of follow-up, adherence to the ABCstroke pathway was associated with a lower risk of the primary composite endpoint (hazard ratio (HR): 0.80; 95% confidence interval (CI): 0.72-0.88), as well as a lower risk of haemorrhagic stroke (subdistribution hazard ratio (SHR): 0.50; 95% CI: 0.38-0.67), heart failure (SHR: 0.771; 95% CI: 0.596-0.998), cardiovascular death (SHR: 0.64; 95% CI: 0.45-0.90), and all-cause mortality (HR: 0.72; 95% CI: 0.62-0.85). Risk reductions in the primary endpoint increased progressively with a higher number of ABCstroke criteria obtained. No significant interaction was observed in the association according to age, sex, or stroke severity.
Conclusions:
In this cohort of Asian patients with first-ever ischaemic stroke, optimal management according to the ABCstroke pathway was associated with a reduction in the risk of adverse outcomes.
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