J Korean Med Sci.  2021 Mar;36(11):e77. 10.3346/jkms.2021.36.e77.

Effect of Transport Time on the Use of Reperfusion Therapy for Patients with Acute Ischemic Stroke in Korea

  • 1Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
  • 2Institute of Medical Science, Jeju National University, Jeju, Korea
  • 3Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
  • 4Department of Neurology, Eulji University Hospital, Daejeon, Korea
  • 5Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea
  • 6Department of Neurology, Seoul Medical Center, Seoul, Korea
  • 7Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
  • 8Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea
  • 9Department of Neurology, Yeungnam University Hospital, Daegu, Korea
  • 10Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
  • 11Department of Neurology, Dong-A University College of Medicine, Busan, Korea
  • 12Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
  • 13Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
  • 14Clinical Research Center, Asan Medical Center, Seoul, Korea
  • 15Department of Neurology, University of California San Francisco, San Francisco, CA, USA


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 (P = 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.


Ischemic Stroke; Reperfusion; Thrombolysis; Endovascular Treatment; Utilization
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