Matsuo Ryu, Yamaguchi Yuko, Matsushita Tomonaga, Hata Jun, Kiyuna Fumi, Fukuda Kenji, Wakisaka Yoshinobu, Kuroda Junya, Ago Tetsuro, Kitazono Takanari, Kamouchi Masahiro
From the Department of Medicine and Clinical Science (R.M., T.M., J.H., F.K., K.F., Y.W., J.K., T.A., T.K.), Department of Health Care Administration and Management (R.M., Y.Y., M.K.), Center for Cohort Study (J.H., Y.W., T.K., M.K.), and Department of Epidemiology and Public Health (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (T.M., K.F.).
Stroke. 2017 Nov;48(11):3049-3056. doi: 10.1161/STROKEAHA.117.018132. Epub 2017 Oct 3.
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.
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 , ≤1 hour; , >1 and ≤2 hours; , >2 and ≤3 hours; , >3 and ≤6 hours; , >6 and ≤12 hours; , >12 and ≤24 hours; and , >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.
Odds ratios (95% confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement (, 2.79 [2.28-3.42]; , 2.49 [2.02-3.07]; , 1.52 [1.21-1.92]; , 1.72 [1.44-2.05], with reference to ) and good functional outcome (, 2.68 [2.05-3.49], 2.10 [1.60-2.77], 1.53 [1.15-2.03], 1.31 [1.05-1.64], with reference to ), 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).
Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after ischemic stroke, regardless of reperfusion treatment or stroke severity.
对于未接受再灌注治疗的患者，早期入院对改善卒中后临床结局的作用尚不清楚。本研究旨在确定早期入院是否与未接受再灌注治疗或轻度卒中患者的良好结局相关。
这项基于医院的多中心研究纳入了2007年7月至2014年12月期间在日本福冈前瞻性登记的6780例连续缺血性卒中患者（年龄69.9±12.2岁；男性占63.9%）。从发病到入院时间分为：≤1小时；>1且≤2小时；>2且≤3小时；>3且≤6小时；>6且≤12小时；>12且≤24小时；>24小时。主要结局为神经功能改善（住院期间美国国立卫生研究院卒中量表评分降低≥4分或出院时评分为0分）和良好的功能结局（3个月改良Rankin量表评分为0 - 1分）。使用逻辑回归分析在调整潜在混杂因素后评估从发病到入院时间与主要结局之间的关联。
在6小时内，从发病到入院时间越短，神经功能改善（相对于>24小时，分别为2.79[2.28 - 3.42]；2.49[2.02 - 3.07]；1.52[1.21 - 1.92]；1.72[1.44 - 2.05]）和良好功能结局（相对于>24小时，分别为2.68[2.05 - 3.49]；2.10[1.60 - 2.77]；1.53[1.15 - 2.03]；1.31[1.05 - 1.64]）的优势比（95%置信区间）显著增加，即使在调整了包括再灌注治疗和基础美国国立卫生研究院卒中量表等潜在混杂因素之后。这些关联在6216例未接受再灌注治疗的患者和4793例轻度卒中患者（入院时美国国立卫生研究院卒中量表≤4分）中依然存在。
卒中发病后6小时内早期入院与缺血性卒中后的良好结局相关，无论是否接受再灌注治疗或卒中严重程度如何。
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