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Observational Study
. 2022 Feb 28;12(1):3252.
doi: 10.1038/s41598-022-06074-1.

Influence of hospital capabilities and prehospital time on outcomes of thrombectomy for stroke in Japan from 2013 to 2016

Ai Kurogi  1 , Daisuke Onozuka  2 , Akihito Hagihara  2 , Kunihiro Nishimura  2 , Akiko Kada  3 , Manabu Hasegawa  4 , Takahiro Higashi  5 , Takanari Kitazono  6 , Tsuyoshi Ohta  7 , Nobuyuki Sakai  8 , Hajime Arai  9 , Susumu Miyamoto  10 , Tetsuya Sakamoto  11 , Koji Iihara  12   13 ; J-ASPECT Study Collaborators
Collaborators, Affiliations
Observational Study

Influence of hospital capabilities and prehospital time on outcomes of thrombectomy for stroke in Japan from 2013 to 2016

Ai Kurogi et al. Sci Rep. .

Abstract

To determine whether increasing thrombectomy-capable hospitals with moderate comprehensive stroke center (CSC) capabilities is a valid alternative to centralization of those with high CSC capabilities. This retrospective, nationwide, observational study used data from the J-ASPECT database linked to national emergency medical service (EMS) records, captured during 2013-2016. We compared the influence of mechanical thrombectomy (MT) use, the CSC score, and the total EMS response time on the modified Rankin Scale score at discharge among patients with acute ischemic stroke transported by ambulance, in phases I (2013-2014, 1461 patients) and II (2015-2016, 3259 patients). We used ordinal logistic regression analyses to analyze outcomes. From phase I to II, MTs increased from 2.7 to 5.5%, and full-time endovascular physicians per hospital decreased. The CSC score and EMS response time remained unchanged. In phase I, higher CSC scores were associated with better outcomes (1-point increase, odds ratio [95% confidence interval]: 0.951 [0.915-0.989]) and longer EMS response time was associated with worse outcomes (1-min increase, 1.007 [1.001-1.013]). In phase II, neither influenced the outcomes. During the transitional shortage of thrombectomy-capable hospitals, increasing hospitals with moderate CSC scores may increase nationwide access to MT, improving outcomes.

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Conflict of interest statement

Dr. Iihara is the principal investigator. Dr. Kada reports receiving personal fees from Bayer Yakuhin, Ltd. outside of the submitted work. Dr. Hagihara reports receiving a KAKENHI grant from the Japan Society for the Promotion of Science and grants from the Japan Agency for Medical Research and Development during the conduct of the study. Dr. Nishimura reports receiving grants from the Japanese Ministry of Health, Labour and Welfare and the Japan Agency for Medical Research and Development during the conduct of the study. Dr. Kitazono reports receiving grants from the Japanese Ministry of Health, Labour and Welfare and the Japan Agency for Medical Research and Development during the conduct of the study; personal fees from Bayer Yakuhin, Ltd., Daiichi Sankyo Co., Ltd., and Chugai Pharmaceutical Co., Ltd.; and grants from Takeda Pharmaceuticals Co., Ltd., Daiichi Sankyo Co., Ltd., Mitsubishi Tanabe Pharma Co, Eisai Co., Ltd., Astellas Pharma Inc., Chugai Pharmaceutical Co., Ltd., and MSD KK, outside of the submitted work. Dr. Ohta reports receiving funding for travel to speak at conference, Takeda Pharmaceutical, Tanabe Mitsubishi, Daiichi Sankyo, Otsuka Pharmaceutical, Stryker, Bayer, Kaneka, MSD, Medicos Hirata, Kyorin Pharmaceutical, Kochi Prefecture Kidney bank society, Uji Tokushukai Hospital, The Japanese Congress of Neurological Surgeons, Eisai, Medtronic and Terumo. He also reports Speakers' Bureaus, Takeda Pharmaceutical , Tanabe Mitsubishi, Daiichi Sankyo, Otsuka Pharmaceutical, Stryker, Bayer, Kaneka, MSD, Medicos Hirata, Kyorin Pharmaceutical , Kochi Prefecture Kidney bank society , Uji Tokushukai Hospital, Eisai, Medtronic and Terumo. Dr. Sakai reports receiving grants from Terumo Co., Ltd. and Daiichi Sankyo Co., Ltd.; and personal fees from Biomedical Solutions Co., Ltd., Johnson and Johnson Co., Ltd., Medtronic Co., Ltd., Penumbra Co., Ltd., Stryker Co., Ltd., and Terumo Co., Ltd., outside of the submitted work. Dr. Higashi reports receiving grants from the Japan Agency for Medical Research and Development and a KAKENHI grant from the Japan Society for the Promotion of Science during the conduct of the study. Dr. Sakamoto reports receiving grants from the Japan Agency for Medical Research and Development during the conduct of the study; personal fees from Boehringer Ingelheim Japan, Inc.; and grants from Asahi Kasei Pharma Corporation, Japan Blood Products Organization, and the Japanese Ministry of Health, Labour and Welfare, outside the submitted work. Dr. Iihara reports receiving grants from the Japanese Ministry of Health, Labour and Welfare, the Japan Agency for Medical Research and Development, and a KAKENHI grant from the Japan Society for the Promotion of Science during the conduct of the study; as well as grants from Otsuka Pharmaceutical Co., Ltd., Kaneka Medix Corporation, Eisai Co., Ltd., and Mitsubishi Tanabe Pharma Co., outside the submitted work. All other authors have nothing to disclose.

Figures

Figure 1
Figure 1
Flow diagram of patients. AIS acute ischemic stroke; EMS emergency medical services; mRS modified Rankin Scale.
Figure 2
Figure 2
Relationships between the total EMS response time or the CSC scores and probabilities of an mRS score of 6 at discharge (stroke outcomes) in the MT group. Panels (a) and (b) show the effects of total EMS response time (minutes) on the probabilities of an mRS score of 6 at discharge in phases I and II, respectively, in the MT group. Panels (c) and (d) show the effects of the CSC scores on the probabilities of an mRS score of 6 at discharge in phases I and II, respectively, in the MT group. EMS emergency medical services; CSC comprehensive stroke center; mRS modified Rankin Scale; MT mechanical thrombectomy.
Figure 3
Figure 3
Subgroup analyses of the effect of the total EMS response time and the CSC score on outcomes. The forest plot shows the effect size of a 1-min increase of the total EMS response time on the mRS score at discharge in phases I (panel a) and II (panel b), respectively, in the MT group, analyzed according to ordinal logistic regression across subgroups. Dots indicate point estimates for the effect of the total EMS response time. The forest plot shows the effect size of a 1-point increase of the CSC score on the mRS score at discharge in phases I (panel c) and II (panel d), respectively, in the MT group, analyzed according to ordinal logistic regression across subgroups. Dots indicate point estimates for the effect of the CSC score. EMS emergency medical services; CSC comprehensive stroke center; mRS modified Rankin Scale; MT mechanical thrombectomy.
See this image and copyright information in PMC

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