Eighteen Years Of Evolving Stroke Care: Quantifying The Impact Of Acute And Secondary Prevention Strategies On Patient Outcomes

초록

Background and Aims: While stroke outcomes have improved over recent decades, it remains unclear which components of advanced stroke care (ASC) have most significantly contributed to these gains. This study aimed to examine 18-year trends in post-stroke outcomes and assess the relative impact of individual ASC components. Methods: We analyzed a prospective cohort of 12,965 patients with acute ischemic stroke (AIS) enrolled from 2004 to 2021 at a regional comprehensive stroke center in South Korea. ASC components included stroke unit care, intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), and discharge medications—dual antiplatelet therapy (DAPT), direct oral anticoagulants (DOACs), and statins. Primary outcomes were 3-month functional status, measured by the utility-weighted modified Rankin Scale (UW-mRS), and a 1-year composite of recurrent stroke, myocardial infarction, or all-cause death. Mediation analysis was used to quantify the contributions of ASC components to outcome trends. Results: From 2004 to 2021, the mean 3-month UW-mRS improved from 0.65 to 0.72, and the 1-year event rate declined from 18.8% to 16.0% (P for trend < .001). Statins contributed most to improved 3-month outcomes (54.1%), followed by DOACs (26.2%) and EVT (16.4%). For 1-year outcomes, statins (7.2%) and DAPT (1.9%) were significant mediators, while DOACs had minimal long-term impact. Conclusions: Sustained improvements in post-stroke outcomes were primarily associated with increased use of evidence-based secondary prevention, particularly statins and DOACs. These findings highlight the need to prioritize secondary prevention alongside acute interventions in modern stroke care.