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Evolving ischemic stroke subtypes in 15 years: A hospital-based observational study. | LitMetric

AI Article Synopsis

  • - From 2004 to 2018 in Hong Kong, the incidence of ischemic strokes decreased significantly, particularly for large artery and small vessel diseases, while the rate of cardioembolic strokes remained stable but increased as a proportion of all strokes.
  • - A major decline in the two-year recurrence rate of intracranial atherothrombotic strokes was linked to more frequent use of statins and dual antiplatelet therapy, while anticoagulation for atrial fibrillation (AF) strokes also showed a significant reduction in recurrence rates.
  • - The study suggests that targeted prevention strategies and better management of risk factors could be effective in reducing strokes due to atherosclerosis, but emphasizes the need for improved screening and

Article Abstract

Background: Depicting the time trends of ischemic stroke subtypes may inform healthcare resource allocation on etiology-based stroke prevention and treatment.

Aim: To reveal the evolving ischemic stroke subtypes from 2004 to 2018.

Methods: We determined the stroke etiologies of consecutive first-ever transient ischemic attack or ischemic stroke patients admitted to a regional hospital in Hong Kong from 2004 to 2018. We analyzed the age-standardized incidences and the two-year recurrence rate of major ischemic stroke subtypes.

Results: Among 6940 patients admitted from 2004 to 2018, age-standardized incidence of ischemic stroke declined from 187.0 to 127.4 per 100,000 population (p < 0.001), driven by the decrease in large artery disease (43.0-9.67 per 100,000 population (p < 0.001)), and small vessel disease (71.9-45.7 per 100,000 population (p < 0.001)). Age-standardized incidence of cardioembolic stroke did not change significantly (p = 0.2). Proportion of cardioembolic stroke increased from 20.4% in 2004-2006 to 29.3% in 2016-2018 (p < 0.001). Two-year recurrence rate of intracranial atherothrombotic stroke reduced from 19.3% to 5.1% (p < 0.001) with increased prescriptions of statin (p < 0.001) and dual antiplatelet therapy (p < 0.001). In parallel with increased anticoagulation use across the study period (p < 0.001), the two-year recurrence of AF-related stroke reduced from 18.9% to 6% (p < 0.001).

Conclusion: Etiology-based risk factor control might have led to the diminishing stroke incidences related to atherosclerosis. To tackle the surge of AF-related strokes, arrhythmia screening, anticoagulation usage, and mechanical thrombectomy service should be reinforced. Comparable preventive strategies might alleviate the enormous stroke burden in mainland China.

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Source
http://dx.doi.org/10.1177/17474930211005953DOI Listing

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