Stroke Care and Application of Thrombolysis in Ibero-America
Authors: Alonso de Leciñana María , Mazya Michael V. , Kostulas Nikolaos , Del Brutto Oscar H. , Abanto Carlos , Massaro Ayrton R. , de Bastos Mario , Martins Sheila , Ameriso Sebastian F. , Gongora-Rivera Fernando , Sacks Claudio , Hoppe Arnold , Abad Patricio , Meza Gloria , Arauz-Gongora Antonio , Wahlgren Nils , Díez-Tejedor Exuperio ,   on behalf of the SITS-SIECV Investigators, Arias Sifontes William , Cerda Margarita , Chávez-Sell Franz , Duran Juan Carlos , de Freitas Gabriel , Martinez Cerrato Jorge , Medina Marco Tulio , Novarro Nelson , Oliveira-Filho Jamary , Pontes Neto Octavio , Perez German Enrique , Salguero Luis , Romano Marina , Gandolfo Claudia , Herrera Gustavo , Jure Lorena , Masih María Elena , Rey Raul , Tomas Facundo Enrique , Martins Magda Carla , Aguilera Carlos , Araya Pablo , Codjambasis Ludwig , Gigoux Juan , Rivas Rodrigo , Muñoz Mario , Vargas Juan Camilo , Alarcón Tomás , Martínez Braulio , Moncayo Jorge , Ruiz-Sandoval José Luis , Villarreal Jorge , Vázquez Rosalía , Nader Juan , Murillo-Bonilla Luis , León Carolina , Benzadón Arón , Triana Ernesto , Olmedo Aurora , Melgarejo Donoband , Paredes Margarita , Ecos Rosa , Solis Frank , Gómez Víctor , Muñoz Greasse , Aparcana Juliana , Uchuya Luis Miguel , Paredes Taly , Peralta Antero , Salcedo Enrique , Huaroto Luis , Vera Luis , Gavidia Martín , Calvo Alejandro , Mariños Evelyn , Sandoval Luis , Vilca Marcos , Valderrama René , Villanueva Isolina , Diez-Canseco Daniel , Barreto Juan , Castillo Guillermo , Lazo Juan Carlos , Cruz José , Duplat Aglaé , Guedes Juan Carlos 
Published: August 2019

Background and Purpose—
Standardized registries may provide valuable data to further improve stroke care. Our aim was to obtain updated information about characteristics of stroke patients and management of stroke across the Ibero-American countries, using a common in-hospital registry (Safe Implementation of Treatments in Stroke–Sociedad Iberoamericana de Enfermedades Cerebrovasculares) as a basis for further quality improvement.

Methods—
Data for this study were entered into the Safe Implementation of Treatments in Stroke registry from September 2009 to December 2013 by 58 centers in 14 countries. Data included demographics, risk factors, onset-to-door time, National Institutes of Health Stroke Scale score, stroke subtype, ischemic stroke etiology, treatments, 3-month mortality, and modified Rankin Scale score. Time to treatment was also recorded for patients treated with thrombolysis.

Results—
Five thousand four hundred one patients were registered; median age, 65 years; 46% women; 3915 (72.5%) ischemic strokes; 686 (13.7%) hemorrhagic strokes; 213 (4.3%) subarachnoid hemorrhages; 414 (8.3%) transient ischemic attacks; and 31 (0.6%) cerebral vein thrombosis. The most prevalent risk factors were hypertension (71.3%), dyslipidemia (35.2%), and diabetes mellitus (23.6%). Atrial fibrillation was present in 15.1%. Three hundred one ischemic strokes were treated with intravenous thrombolysis (IVT; 7.7%). Patients undergoing IVT were more severely affected (median baseline National Institutes of Health Stroke Scale score, 11 versus 6). The rate of symptomatic intracerebral hemorrhages after IVT was 5.7%. At 3 months, 60.3% of IVT-treated patients and 59.1% of untreated patients were independent (modified Rankin Scale score, 0–2). Mortality was 11.4% in treated and 12.8% in untreated patients.

Conclusions—
Safe Implementation of Treatments in Stroke–Sociedad Iberoamericana de Enfermedades Cerebrovasculares is the largest registry of a general stroke population and the first study to evaluate the level of IVT use in Ibero-America. It provides valuable information that may help to improve the quality of stroke care in the Ibero-American region.