Improvement in Delivery of Ischemic Stroke Treatments but Stagnation of Clinical Outcomes in Young Adults in South Korea

Background There is limited information on the delivery of acute stroke therapies and secondary preventive measures and clinical outcomes over time in young adults with acute ischemic stroke (AIS). This study investigated whether advances in these treatments improved outcomes in this population. Methods Using a prospective multicenter stroke registry in Korea, young adults (aged 18–50 years) with AIS hospitalized between 2008 and 2019 were identified. The observation period was divided into four epochs: 2008–2010, 2011–2013, 2014–2016, and 2017–2019. Secular trends for patient characteristics, treatments, and outcomes were analyzed. Results A total of 7,050 eligible patients (mean age 43.1; men 71.9%) were registered. The mean age decreased from 43.6 to 42.9 years (P trend =0.01). Current smoking decreased, whereas obesity increased. Other risk factors remained unchanged. Intravenous thrombolysis and mechanical thrombectomy rates increased over time from 2008–2010 to 2017–2019 (9.5% to 13.8% and 3.2% to 9.2%, respectively; P trend ’s<0.01). Door-to-needle time improved (P trend <.001), but onset-to-door and door-to-puncture time remained constant. Secondary prevention including the administration of dual antiplatelets for noncardioembolic minor stroke (26.7% to 47.0%), direct oral anticoagulants for atrial fibrillation (0.0% to 56.2%), and statins for large artery atherosclerosis (76.1% to 95.3%) increased (P trend ’s<0.01). Outcome data were available from 2011. One-year mortality (2.5% in 2011–2013 and 2.3% in 2017–2019) and 3-month modified Rankin scale scores 0–1 (68.3% to 69.1%) and 0–2 (87.6% to 86.2%) remained unchanged. The one-year stroke recurrence rate increased (4.1% to 5.5%, P trend =0.04), altough the differnce was not significant after adjusting for sex and age. Conclusion Improvements in the delivery of acute stroke treatments did not necessarily lead to better outcomes in young adults with AIS over the past decade, indicating a need for further progress.