Trends in reperfusion treatments, functional outcomes and mortality for first-ever ischaemic stroke in Norway from 2014 to 2021: The Norwegian Stroke Registry.

INTRODUCTION

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.

PATIENTS AND METHODS

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.

RESULTS

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.

DISCUSSION AND CONCLUSION

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.