Temporal Trends and Contributions of Acute Therapies and Secondary Prevention to Improved Stroke Outcomes: A Long-Term Cohort Study

초록

Background: Whether advances in stroke care have directly translated into improved post-stroke outcomes—and which specific components have contributed most—remains unclear. This study aimed to evaluate 18-year trends in post-stroke outcomes and to quantify the relative contribution of individual components of advanced stroke care (ASC). Methods: We analyzed data from 12,965 consecutive patients with acute ischemic stroke enrolled in a single-center stroke registry between 2004 and 2021. ASC components included stroke unit care, intravenous thrombolysis, endovascular thrombectomy (EVT), and discharge medications: dual antiplatelet therapy (DAPT), direct oral anticoagulants (DOACs), and statins. Primary outcomes were the 3-month utility-weighted modified Rankin Scale (UW-mRS) and the 1-year composite of recurrent stroke, myocardial infarction, or death. Mediation analysis was used to estimate the extent to which each ASC component contributed to outcome improvements over time. Results: Their mean age was 67.8 years, and 59.9% were men. Over 18 years, the 3-month UW-mRS improved from 0.65 to 0.72, and the 1-year composite event rate declined from 18.8% to 16.0% (P’s for trend < 0.001). Mediation analysis showed that statin use at discharge accounted for the largest share of the improvement in 3-month outcomes (54.1%), followed by DOACs (26.2%) and EVT (16.4%). For the 1-year outcome, statins (7.2%) and DAPT (1.9%) were significant mediators, while DOACs had minimal long-term effect. Conclusion: Stroke outcomes improved substantially over the past two decades, largely due to the expanded use of evidence-based secondary prevention therapies. These findings highlight the importance of sustained implementation of secondary prevention alongside acute-phase interventions in optimizing long-term stroke outcomes. © 2026 The Korean Academy of Medical Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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