TY - JOUR
T1 - Association between onset-to-door time and clinical outcomes after ischemic stroke
AU - Matsuo, Ryu
AU - Yamaguchi, Yuko
AU - Matsushita, Tomonaga
AU - Hata, Jun
AU - Kiyuna, Fumi
AU - Fukuda, Kenji
AU - Wakisaka, Yoshinobu
AU - Kuroda, Junya
AU - Ago, Tetsuro
AU - Kitazono, Takanari
AU - Kamouchi, Masahiro
AU - Ishitsuka, Takao
AU - Ibayashi, Setsuro
AU - Kusuda, Kenji
AU - Fujii, Kenichiro
AU - Nagao, Tetsuhiko
AU - Okada, Yasushi
AU - Yasaka, Masahiro
AU - Ooboshi, Hiroaki
AU - Irie, Katsumi
AU - Omae, Tsuyoshi
AU - Toyoda, Kazunori
AU - Nakane, Hiroshi
AU - Sugimori, Hiroshi
AU - Arakawa, Shuji
AU - Kitayama, Jiro
AU - Fujimoto, Shigeru
AU - Arihiro, Shoji
AU - Fukushima, Yoshihisa
N1 - Funding Information:
This study was supported by the Japan Society for the Promotion of Science, Grant-in-Aid for Scientific Research, grant numbers 26293158, 15K08849, and 17H04143 from the Japanese Ministry of Education, Culture, Sports, Science and Technology.
Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017/11
Y1 - 2017/11
N2 - Background and Purpose-The role of early hospital arrival in improving poststroke clinical outcomes in patients without reperfusion treatment remains unclear. This study aimed to determine whether early hospital arrival was associated with favorable outcomes in patients without reperfusion treatment or with minor stroke. Methods-This multicenter, hospital-based study included 6780 consecutive patients (aged, 69.9±12.2 years; 63.9% men) with ischemic stroke who were prospectively registered in Fukuoka, Japan, between July 2007 and December 2014. Onset-to-door time was categorized as T0-1, ≤1 hour; T1-2, >1 and ≤2 hours; T2-3, >2 and ≤3 hours; T3-6, >3 and ≤6 hours; T6-12, >6 and ≤12 hours; T12-24, >12 and ≤24 hours; and T24-, >24 hours. The main outcomes were neurological improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 during hospitalization or 0 at discharge) and good functional outcome (3-month modified Rankin Scale score of 0-1). Associations between onset-to-door time and main outcomes were evaluated after adjusting for potential confounders using logistic regression analysis. Results-Odds ratios (95% confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement (T0-1, 2.79 [2.28-3.42]; T1-2, 2.49 [2.02-3.07]; T2-3, 1.52 [1.21-1.92]; T3-6, 1.72 [1.44-2.05], with reference to T24-) and good functional outcome (T0-1, 2.68 [2.05-3.49], T1-2 2.10 [1.60-2.77], T2-3 1.53 [1.15-2.03], T3-6 1.31 [1.05-1.64], with reference to T24-), even after adjusting for potential confounding factors including reperfusion treatment and basal National Institutes of Health Stroke Scale. These associations were maintained in 6216 patients without reperfusion treatment and in 4793 patients with minor stroke (National Institutes of Health Stroke Scale ≤4 on hospital arrival). Conclusions-Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after ischemic stroke, regardless of reperfusion treatment or stroke severity.
AB - Background and Purpose-The role of early hospital arrival in improving poststroke clinical outcomes in patients without reperfusion treatment remains unclear. This study aimed to determine whether early hospital arrival was associated with favorable outcomes in patients without reperfusion treatment or with minor stroke. Methods-This multicenter, hospital-based study included 6780 consecutive patients (aged, 69.9±12.2 years; 63.9% men) with ischemic stroke who were prospectively registered in Fukuoka, Japan, between July 2007 and December 2014. Onset-to-door time was categorized as T0-1, ≤1 hour; T1-2, >1 and ≤2 hours; T2-3, >2 and ≤3 hours; T3-6, >3 and ≤6 hours; T6-12, >6 and ≤12 hours; T12-24, >12 and ≤24 hours; and T24-, >24 hours. The main outcomes were neurological improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 during hospitalization or 0 at discharge) and good functional outcome (3-month modified Rankin Scale score of 0-1). Associations between onset-to-door time and main outcomes were evaluated after adjusting for potential confounders using logistic regression analysis. Results-Odds ratios (95% confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement (T0-1, 2.79 [2.28-3.42]; T1-2, 2.49 [2.02-3.07]; T2-3, 1.52 [1.21-1.92]; T3-6, 1.72 [1.44-2.05], with reference to T24-) and good functional outcome (T0-1, 2.68 [2.05-3.49], T1-2 2.10 [1.60-2.77], T2-3 1.53 [1.15-2.03], T3-6 1.31 [1.05-1.64], with reference to T24-), even after adjusting for potential confounding factors including reperfusion treatment and basal National Institutes of Health Stroke Scale. These associations were maintained in 6216 patients without reperfusion treatment and in 4793 patients with minor stroke (National Institutes of Health Stroke Scale ≤4 on hospital arrival). Conclusions-Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after ischemic stroke, regardless of reperfusion treatment or stroke severity.
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U2 - 10.1161/STROKEAHA.117.018132
DO - 10.1161/STROKEAHA.117.018132
M3 - Article
C2 - 28974631
AN - SCOPUS:85032157303
VL - 48
SP - 3049
EP - 3056
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 11
ER -