Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Stroke. 2012 Aug;43(8):2136-41. doi: 10.1161/STROKEAHA.111.647610. Epub 2012 May 8.
Improving stroke management, guideline adherence, and outcome is a global priority. Our aim was to examine trends in nationwide use of reperfusion therapy, stroke in-hospital management, and outcome.
Data were based on the triennial 2-month period of the National Acute Stroke Israeli registry (February to March 2004, March to April 2007, April to May 2010). The registry includes unselected patients admitted to all hospitals nationwide. There were in total 6279 patients: ischemic stroke, 4452 (70.9%); intracerebral hemorrhage, 485 (7.7%); undetermined stroke, 97 (1.6%); and transient ischemic attacks, 1245 (19.8%).
Overall use of reperfusion therapy for acute ischemic stroke increased from 0.4% in 2004% to 5.9% in 2010 (P<0.001; adjusted OR, 17.0; 95% CI, 7.5-38.7). Use of CT or MR angiography for ischemic events increased from 2.1% in 2004% to 16.6% in 2010 (P<0.001; adjusted OR, 9.7; 95% CI, 6.8-13.9). Overall use of antithrombotics and anticoagulation for atrial fibrillation did not differ between periods, whereas clopidogrel use increased nearly 3-fold to 41% and statin use nearly 2-fold to 68%. The relative odds of providing reperfusion therapy, using CT or MR angiography, and prescribing anticoagulants for atrial fibrillation were higher among hospitals with large as compared with small stroke patient volumes. In-hospital mortality after acute ischemic stroke decreased from 7.2% in 2004 to 3.9% in 2010 (P<0.001; adjusted OR, 0.7; 95% CI, 0.4-1.0), whereas there was no significant change in odds of poor functional outcome.
Based on a nationwide stroke registry, use of reperfusion therapy, vascular imaging, and statins is steadily increasing, whereas in-hospital mortality is decreasing.
改善中风管理、遵循指南和改善结局是全球的重点。我们的目的是研究全国范围内再灌注治疗、中风院内管理和结局的使用趋势。
数据基于全国急性中风以色列登记处（2004 年 2 月至 3 月、2007 年 3 月至 4 月、2010 年 4 月至 5 月）的每三年两个月的两月期。该登记处包括全国所有医院收治的未经选择的患者。共有 6279 名患者：缺血性中风 4452 例（70.9%）；脑出血 485 例（7.7%）；未确定的中风 97 例（1.6%）；短暂性脑缺血发作 1245 例（19.8%）。
急性缺血性中风的再灌注治疗总体使用率从 2004 年的 0.4%增加到 2010 年的 5.9%（P<0.001；调整后的 OR，17.0；95%CI，7.5-38.7）。用于缺血性事件的 CT 或 MR 血管造影的使用率从 2004 年的 2.1%增加到 2010 年的 16.6%（P<0.001；调整后的 OR，9.7；95%CI，6.8-13.9）。两个时期的抗血栓形成和抗凝治疗心房颤动的抗血小板和抗凝药物的使用没有差异，而氯吡格雷的使用率增加了近 3 倍，达到 41%，他汀类药物的使用率增加了近 2 倍，达到 68%。与小脑卒中患者量的医院相比，大脑卒中患者量的医院提供再灌注治疗、使用 CT 或 MR 血管造影和开处抗凝药物治疗心房颤动的相对几率更高。急性缺血性中风后的院内死亡率从 2004 年的 7.2%降至 2010 年的 3.9%（P<0.001；调整后的 OR，0.7；95%CI，0.4-1.0），而不良功能结局的几率没有明显变化。
基于全国性的中风登记处，再灌注治疗、血管成像和他汀类药物的使用稳步增加，而院内死亡率正在下降。
