Impact of stroke center certification on rt-PA thrombolysis after acute ischemic stroke in South China from 2015 to 2020
Impact of stroke center certification on rt-PA thrombolysis after acute ischemic stroke in South China from 2015 to 2020
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DOI：
10.1177/17474930211031440
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发表时间：
2021-07
影响因子：
6.7
通讯作者：
Yicong Chen;Jiaoxing Li;C. Dang;Shuangquan Tan;Fubing Ouyang;Jianle Li;Jian Yu;J. Zeng;Yuhua Fan
中科院分区：
文献类型：
--
作者：
Yicong Chen;Jiaoxing Li;C. Dang;Shuangquan Tan;Fubing Ouyang;Jianle Li;Jian Yu;J. Zeng;Yuhua Fan
背景和目的在中国，卒中中心认证于2015年启动，但其对静脉溶栓的影响知之甚少。本研究旨在评价中国南方卒中中心认证对静脉溶栓治疗使用的影响。方法回顾性分析2015 - 2020年广东省21个地市重组组织型纤溶酶原激活剂（rt-PA）使用情况。年溶栓率定义为接受静脉rt-PA治疗的患者人数除以同一年内发生急性缺血性卒中的患者人数。卒中中心的密度计算为卒中中心的数量除以相应的居民。采用斯皮尔曼相关分析确定年溶栓率与卒中中心数量/密度之间的相关性。采用配对t检验比较卒中中心建立前后年溶栓率的增长差异。结果2015 - 2020年，广东省rt-PA溶栓率从1.4%上升到7.2%，卒中中心数量从0个增加到82个，卒中中心密度从0.00/百万人口增加到0.71/百万人口。2016 - 2020年卒中中心rt-PA年均使用量高于非卒中中心（均P < 0.05）。2018 - 2020年21个城市的年溶栓率与卒中中心数量（r = 1.00，P = 0.0028）、卒中中心密度呈正相关（均P < 0.05）。在卒中中心设立后，城市一级的年溶栓率增长显著加快（1.55%/年vs.0.77%/年，P < 0.001）。结论卒中中心认证可能部分推动rt-PA溶栓的使用增加。卒中中心认证应继续推广，以促进急性缺血性卒中患者获得静脉溶栓治疗。
Background and purpose In China, stroke center certification was launched in 2015, but little is known about its impact on intravenous thrombolysis. This study aimed to evaluate the effects of stroke center certification on the use of intravenous thrombolysis during a five-year period in South China. Methods We retrospectively collected data regarding the use of recombinant tissue plasminogen activator (rt-PA) in 21 cities of Guangdong from 2015 to 2020. The annual thrombolysis rate was defined as the number of patients who underwent intravenous rt-PA therapy divided by the number of those who had acute ischemic stroke within the same year. The density of stroke centers was calculated as the number of stroke centers divided by the corresponding residents. Spearman’s correlation analysis was used to determine the correlations between the annual thrombolysis rates and the number/density of stroke centers. Paired t-test was used to compare differences in growth in annual thrombolysis rates before and after having stroke centers. Results From 2015 to 2020, the annual rt-PA thrombolysis rates of Guangdong increased from 1.4% to 7.2%, which was accompanied by an increase in the number of stroke centers from 0 to 82 and density of stroke centers from 0.00 to 0.71 per million population. The average annual rt-PA use in stroke centers was higher than that in non-stroke centers from 2016 to 2020 (all P < 0.05). There was a positive correlation of annual thrombolysis rates with the number of stroke centers (r = 1.00, P = 0.0028) and with the density of stroke centers in the 21 cities from 2018 to 2020 (all P < 0.05). The growth in annual thrombolysis rates significantly accelerated at the city-level after having stroke centers (1.55%/y vs. 0.77%/y, P < 0.001). Conclusions Stroke center certification may partially drive the increased use of rt-PA thrombolysis. Stroke center certification should be continually promoted to facilitate access to intravenous thrombolysis for patients with acute ischemic stroke.