Supplementary Material for: Trends of the Incidence of Ischemic Stroke Thrombolysis over Seven Years and One-Year Outcome: A Population-Based Study in Joinville, Brazil

<b><i>Background:</i></b> In a population-based setting, we aimed to measure the incidence trends of ischemic stroke (IS) thrombolysis, thrombolysis times, proportion of symptomatic intracerebral hemorrhage (sICH), 30-day case fatality and functional outcomes. We also compared the 12-month functional status between thrombolyzed and nonthrombolyzed patients. <b><i>Methods:</i></b> Using data from the Joinville Population-Based Stroke Registry, we prospectively ascertained a cohort of all thrombolyses done in Joinville citizens, Southern Brazil, from 2005 to 2011. For the definition of sICH we used European Cooperative Acute Stroke Study (ECASS) II criteria. <b><i>Results:</i></b> Over 7 years, 6% (220/3,552) of all IS were thrombolyzed. The thrombolysis incidence increased from 1.4 [95% confidence interval (CI), 0.6-2.9] in 2005 to 9.8 (7.3-12.9) per 100,000 population in 2011 (p &lt; 0.0001). The thrombolysis incidence age-adjusted to the world population in 2011 was 11 (8.2-14.3) per 100,000. Only 30% (50/165) were thrombolyzed within 1 h of arrival at hospital. In 7 days, 6.4% (14/220) had sICH and 57% (8/14) of those died. In the 2009-2011 period, a favorable functional outcome [modified Rankin scale (mRS) 0-1] at 12 months among patients who received thrombolysis was more frequent [mRS 0-1; 36% (38/107)] than among patients who did not receive thrombolysis [mRS 0-1; 24% (131/544); p = 0.016]. The logistic regression showed that thrombolyzed IS patients had a more favorable outcome (mRS 0-1; HR 2.13; 95% CI, 1.2-3.7; p &lt; 0.016) than nonthrombolyzed patients. <b><i>Conclusion:</i></b> In a population setting of a middle income country, the thrombolysis incidence and outcomes were similar to those of other well-structured services. After 1 year, patients thrombolyzed in the 4.5-hour time window had a better outcome. More than proportions, rates provide additional information and could be used to benchmark services against others.

<b><i>背景：</i></b> 本研究基于人群队列场景，旨在探究缺血性脑卒中（ischemic stroke, IS）溶栓治疗的发病趋势、溶栓时机、症状性颅内出血（symptomatic intracerebral hemorrhage, sICH）占比、30天病死率及功能预后情况，并对比接受溶栓治疗与未接受溶栓治疗患者的12个月功能状态。<b><i>方法：</i></b> 本研究使用巴西南部若因维利的人群卒中登记库数据，前瞻性纳入2005年至2011年间当地所有接受溶栓治疗的若因维利市民组成研究队列。本研究采用欧洲急性卒中协作研究（European Cooperative Acute Stroke Study, ECASS）II标准定义症状性颅内出血。<b><i>结果：</i></b> 7年间，全部缺血性脑卒中病例中有6%（220/3552）接受了溶栓治疗。溶栓治疗发病率从2005年的1.4[95%置信区间（confidence interval, CI）：0.6~2.9]/10万人口，升至2011年的9.8（7.3~12.9）/10万人口（p<0.0001）。2011年经世界标准人口年龄标化后的溶栓发病率为11（8.2~14.3）/10万人口。仅30%（50/165）的患者在抵达医院后1小时内接受了溶栓治疗。发病后7天内，6.4%（14/220）的患者出现症状性颅内出血，其中57%（8/14）的患者死亡。在2009年至2011年期间，接受溶栓治疗的患者中，12个月时获得良好功能预后[改良Rankin量表（modified Rankin scale, mRS）评分0~1分]的比例[36%（38/107）]显著高于未接受溶栓治疗的患者[24%（131/544）；p=0.016]。Logistic回归分析显示，接受溶栓治疗的缺血性脑卒中患者较未接受者拥有更优的功能预后（mRS 0~1分；风险比（hazard ratio, HR）2.13；95%CI：1.2~3.7；p<0.016）。<b><i>结论：</i></b> 在中等收入国家的人群队列研究场景中，溶栓治疗的发病率与预后情况与其他结构完善的医疗服务体系相仿。在发病4.5小时时间窗内接受溶栓治疗的患者，其1年后的预后更佳。相较于单纯的比例数据，发病率指标可提供更多信息，可用于不同医疗服务机构间的绩效对标。