Epidemiology, risk factors, and emergency care for ischemic stroke in the urban center of the north of West Siberia: 20-year study experience

Abstract

Objective: to study the epidemiology, risk factors, clinical course, and outcomes of ischemic stroke (IS) on the basis of a 20-year follow-up of patients in Surgut (Khanty-Mansi Autonomous District (KMAD)). Patients and methods. About 9 thousand patients with IS were followed up during the study. The follow-up results obtained in 1990, 2000, and 2012 were compared. The study was conducted in accordance with the procedure described in the Register of Stroke, by using the records of neurological hospitals of the town, its emergency service, urban polyclinics, and forensic medical examination bureau. Results. The incidence of IS significantly increased in Surgut in the examined period: there were about 300 primary and secondary IS cases in 1990; about 600 in 2000, and above 1,000 in 2012; the increment being nearly 100% per decade. The rise in the incidence of IS was due to the higher prevalence of its major risk factors: hypertension (by 42%), atherosclerosis (by 24%), diabetes mellitus (by 101%), and cardiac arrhythmia (by 18%). Major cerebral artery (MCA) stenosis and occlusion were identified in 162 (43.2%) of 375 IS cases with their neuroimaging diagnosis. The rate of MCA stenotic lesions was not high, increased with age, and assumed considerable significance in patients over 51–55 years of age. There was a seasonal non-uniform pattern of morbidity, its peak (about 70% of IS) occurred in May-June (this is a spring in the KMAD) when there was a dramatic interdiurnal variability in major meteorological factors. The clinical course of stroke was characterized by relatively favorable outcomes, low mortality rates that declined from 14.5% in 1990 to 6.7% in 2012, which stemmed from the improved delivery of health care.