The crude incidence rate of stroke hovered around 200 (per 100,000 person-years) from 2011 to 2015, then surged to 218.4 in 2019, before marginally declining to 208.0 in 2020. [1] 

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From 2011 to 2019, there was a reduction in the 30-day case fatality rates for both total stroke and first stroke, with rates decreasing from 8.5% to 7.4% and 9.0% to 7.7%, respectively. [1] 

Notably, the rate of increase in the number of stroke events was more pronounced in males compared to females, resulting in an increase in the male-to-female ratio from 1.1 in 2011 to 1.3 in 2020. [1] 

Among the reported stroke cases in 2020, individuals aged 80 years and older accounted for the largest proportion, with 29,177 cases (24.5%), followed by 28,143 cases (23.6%) among those aged 70–79 years and 24,420 cases (20.5%) among those aged 60–69 years. The number of cases in the 50–59, 40–49, and 30–39 age groups were 16,102 (13.5%), 6,230 (5.2%), and 1,846 (1.5%), respectively. [1]  Age-specific sex ratios show that men were more prevalent in the middle-aged group (55–64 years), while women were more common in the older age group (≥ 85 years), a finding consistent with prior research. The mean age was 72.9 ± 13.4 years for women and 66.6 ± 12.9 years for men in 2021. [2] 

In 2008, an insignificant difference was observed between the 30-day mortality rate for ischemic stroke patients in urban (3.6%) and rural (3.8%) areas (RR: 1.0). By 2019, improvements were observed in both areas (urban: 2.4%; rural: 2.6%; RR: 1.0). The decline in both areas was more notable in urban areas (average annual percent change: -3.5%) than in rural areas (average annual percent change: -2.4%) [3] 

The TOAST (Trial of ORG 10172 in Acute Stroke Treatment) Classification system includes five categories: 1) large-artery atherosclerosis, 2) cardioembolism, 3) small-artery occlusion (lacune), 4) stroke of other determined etiology, and 5) stroke of undetermined etiology. [4]  Based on the TOAST Classification, the distribution of ischemic stroke subtypes in Korea in 2021 was as follows: large-artery atherosclerosis accounted for the largest proportion at 38.2%, followed by cardioembolism at 19.5% and small-vessel occlusion at 17.9%. Strokes of other determined etiology comprised 4.6% of cases. [2] 

About half of ischemic and hemorrhagic stroke cases had Korean-National Institute of health stroke scale (NIHSS) of four or lower. Severe neurological deficits at symptom onset (NIHSS scores of 25 or higher) were more common in hemorrhagic stroke than in ischemic stroke (13.9% vs. 1.5%). [5] 

In 2021, hypertension was the most prevalent modifiable risk factor, affecting 67.4% of acute ischemic stroke cases. [2] 

Diagnoses are based on clinical features and on data collected by tests such as brain imaging, cardiac imaging, duplex imaging of extracranial arteries, arteriography, and laboratory assessments for a prothrombotic state. [4]  Patients who were diagnosed of I63 (cerebral infarction) at discharge or had hemorrhagic complication by intravenous thrombolysis (IVT) or endovascular treatment (EVT), were classified as ischemic stroke. [6] 

Antithrombotic drugs were administered to 94% of acute ischemic stroke patients within 48 hours of hospitalization in 2021, aligning closely with the US rate of 97%. Aspirin monotherapy was the most common treatment until 2016, but the combination of aspirin plus clopidogrel became the preferred regimen after 2017, used in 65% of cases by 2021. [2]  Notably, the use of Direct oral anticoagulants (DOACs) for cardioembolism stroke without atrial fibrillation increased to 26% in 2021, while warfarin usage significantly dropped from 39% in 2008–2010 to 12% in 2021, indicating a significant shift in anticoagulation practices that merits further investigation. [2] 

In the study cohort, 3-month and 1-year modified Rankin Scale (mRS) scores were collected for 97% and 93% of patients, respectively. In 2021, 63% of all AIS patients achieved favorable outcomes (mRS 0–2) at 3 months, with 55% of those receiving intravenous thrombolysis (IVT) and 41% undergoing endovascular treatment (EVT) achieving similar outcomes. Excellent 3-month outcomes (mRS 0–1) were seen in 48% of all AIS patients and 39% of those receiving IVT, surpassing the 31% reported in a meta-analysis of IVT trials. For 2021, favorable one-year outcomes were observed in 64% of AIS patients, with excellent one-year outcomes reported at 49% for 2020. [2] 

Polymorphisms in PAI-1 were identified by polymerase chain reaction/restriction fragment length polymorphism analysis using genomic DNA. Specifically, three variations (−675 4G>5G, 10692T>C, and 12068G>A) were linked to a higher overall prevalence of stroke as well as a higher prevalence of certain stroke subtypes. Haplotype analyses also revealed combinations of these variations (−844G>A, −675 4G>5G, 43G>A, 9785A>G, 10692T>C, 11053T>G, and 12068G>A) that were significantly associated with a higher prevalence of ischemic stroke. [7] 

[1] Incidence and case fatality of stroke in Korea, 2011-2020. Epidemiol Health. 2024;46.e2024003.  [2] Contemporary Statistics of Acute Ischemic Stroke and Transient Ischemic Attack in 2021: Insights From the CRCS-K-NIH Registry. J Korean Med Sci. 2024 Aug;39(34):e278. [3] Mortality and Disparities of Acute Myocardial Infarction and Stroke in Korea, 2008–2019. Yonsei Med J. 2024 Sep;65(9):534-543. [4] Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment. Stroke. (1993) 24:35–41. [5] Executive Summary of Stroke Statistics in Korea 2018: A Report from the Epidemiology Research Council of the Korean Stroke Society. J Stroke. 2019 Jan;21(1):42-59. [6] Stroke Statistics in Korea 2018: A Report from the Epidemiology Research Council of the Korean Stroke Society. The Epidemiology Research Council of the Korean Stroke Society (2018) [7] Association between PAI-1 Polymorphisms and Ischemic Stroke in a South Korean Case-Control Cohort. International Journal of Molecular Sciences. 2023