Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea.
Institute of Medical Science, Jeju National University, Jeju, Korea.
J Korean Med Sci. 2021 Mar 22;36(11):e77. doi: 10.3346/jkms.2021.36.e77.
We investigated the association between geographic proximity to hospitals and the administration rate of reperfusion therapy for acute ischemic stroke.
We identified patients with acute ischemic stroke who visited the hospital within 12 hours of symptom onset from a prospective nationwide multicenter stroke registry. Reperfusion therapy was classified as intravenous thrombolysis (IVT), endovascular therapy (EVT), or combined therapy. The association between the proportion of patients who were treated with reperfusion therapy and the ground transport time was evaluated using a spline regression analysis adjusted for patient-level characteristics. We also estimated the proportion of Korean population that lived within each 30-minute incremental service area from 67 stroke centers accredited by the Korean Stroke Society.
Of 12,172 patients (mean age, 68 ± 13 years; men, 59.7%) who met the eligibility criteria, 96.5% lived within 90 minutes of ground transport time from the admitting hospital. The proportion of patients treated with IVT decreased significantly when stroke patients lived beyond 90 minutes of the transport time ( = 0.006). The proportion treated with EVT also showed a similar trend with the transport time. Based on the residential area, 98.4% of Korean population was accessible to 67 stroke centers within 90 minutes.
The use of reperfusion therapy for acute stroke decreased when patients lived beyond 90 minutes of the ground transport time from the hospital. More than 95% of the South Korean population was accessible to 67 stroke centers within 90 minutes of the ground transport time.
我们研究了与医院的地理接近程度与急性缺血性脑卒中再灌注治疗的实施率之间的关系。
我们从一项前瞻性全国多中心脑卒中注册研究中确定了发病后 12 小时内到医院就诊的急性缺血性脑卒中患者。再灌注治疗分为静脉溶栓治疗（IVT）、血管内治疗（EVT）或联合治疗。使用样条回归分析调整患者水平特征后，评估接受再灌注治疗的患者比例与地面转运时间之间的关系。我们还估计了韩国卒中学会认证的 67 个卒中中心每 30 分钟服务区域内居住的韩国人口比例。
在符合入选标准的 12172 名患者中（平均年龄 68 ± 13 岁；男性占 59.7%），96.5%的患者居住在距离入院医院地面转运时间 90 分钟以内的地方。当脑卒中患者的转运时间超过 90 分钟时，接受 IVT 治疗的患者比例显著下降（ = 0.006）。接受 EVT 治疗的患者比例也表现出与转运时间相似的趋势。根据居住区域，98.4%的韩国人口在 90 分钟内可到达 67 个卒中中心。
当患者从医院的地面转运时间超过 90 分钟时，急性脑卒中再灌注治疗的应用率会下降。超过 95%的韩国人口在 90 分钟的地面转运时间内可到达 67 个卒中中心。
