Elangwe Kevin C, Mathiesen Ellisiv B, Varmdal Torunn, Indredavik Bent, Eltoft Agnethe
Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
Department of Neurology, University Hospital of North Norway, Tromsø, Norway.
Eur Stroke J. 2025 Apr 13:23969873251331482. doi: 10.1177/23969873251331482.
Acute ischaemic stroke (AIS) treatment has undergone major changes in the last decades with regards to reperfusion treatment with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT). We analysed temporal trends in reperfusion treatment, functional outcomes and mortality among patients with first-ever AIS.
We included 45,686 first-ever AIS patients registered in the Norwegian Stroke Registry from 2014 to 2021. Temporal trends in reperfusion therapy, functional outcome defined by modified Rankin Scale (mRS) score at 90 days and mortality were assessed in age-and sex-adjusted logistic regression models and in analyses stratified by age and reperfusion treatment.
Mean age was 73.8 years and 54.5% were men. The use of reperfusion treatment increased over time (IVT only from 15.5% to 18.1%; MT only from 0.4% to 2.8%; IVT + MT combined, from 0.9% to 3.4%). The proportion of patients achieving mRS 0-2 at 90 days increased from 64.2% to 68.1%. The 90-day mortality decreased from 11.7% to 10.5%. Improvement in 90-day functional outcome was most notable in patients receiving IVT, but was also observed in patients not receiving reperfusion treatment. Patients aged ⩾80 years showed improvement in functional outcome and reduced mortality rate, while less noticeable time trends were observed in patients <80 years.
Reperfusion therapy for first-ever AIS increased significantly over time, concurrent with significant improvements in functional outcome and lower mortality rate. Improvements in outcome were more prominent in the older population. Improved outcome among non-reperfused patients suggest that factors other than reperfusion therapy contribute to these results.
在过去几十年中，急性缺血性卒中（AIS）的治疗在静脉溶栓（IVT）和机械取栓（MT）的再灌注治疗方面发生了重大变化。我们分析了首次发生AIS患者的再灌注治疗、功能结局和死亡率的时间趋势。
我们纳入了2014年至2021年在挪威卒中登记处登记的45686例首次发生AIS的患者。在年龄和性别调整的逻辑回归模型以及按年龄和再灌注治疗分层的分析中，评估了再灌注治疗的时间趋势、90天时根据改良Rankin量表（mRS）评分定义的功能结局和死亡率。
平均年龄为73.8岁，男性占54.5%。再灌注治疗的使用随时间增加（仅IVT从15.5%增至18.1%；仅MT从0.4%增至2.8%；IVT + MT联合治疗从0.9%增至3.4%）。90天时mRS评分为0 - 2的患者比例从64.2%增至68.1%。90天死亡率从11.7%降至10.5%。90天功能结局的改善在接受IVT的患者中最为显著，但在未接受再灌注治疗的患者中也有观察到。年龄≥80岁的患者功能结局有所改善，死亡率降低，而年龄<80岁的患者时间趋势不太明显。
首次发生AIS的再灌注治疗随时间显著增加，同时功能结局显著改善，死亡率降低。老年人群的结局改善更为突出。未接受再灌注治疗患者的结局改善表明，除再灌注治疗外的其他因素促成了这些结果。
