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Introduction: In recent years, the treatment of the acute phase of cerebral infarction such as tPA and endovascular thrombectomy has been rapidly changing, and development of a medical system for acute cerebral infarction is desired.Objective: To examine the effect of tPA and endovascular thrombectomy on mortality in patients with acute ischemic stroke in the nationwide 5 years hospital cohort in Japan.Methods: We conducted annual nationwide survey from 2011 to 2015 using data from the Japanese Diagnosis Procedure Combination database on patients hospitalized with ischemic and hemorrhagic stroke in a nationwide hospital cohort in Japan (J-ASPECT Study). The effect of tPA or endovascular thrombectomy on stroke mortality was analyzed by mixed effect model with years (from 2011 to 2015), age, gender, Japan Coma Scale (JCS), and Comprehensive stroke care (CSC) score as a fixed effect, and hospital as a random effect. CSC score was developed by our study group based on the institutional survey conducted in 2011.Results: The total numbers of patients were 292,230 in ischemic stroke. In 5 years, the proportion of tPA or endovascular thrombectomy has increased from 7.2% to 8.4%, while the mortality has decreased from 7.6% to 5.5%. The mortality varied by JCS, which was 37.5% for JCS 3 digit, 15.4% for JCS 2 digit, 4.8% for JCS 1 digit and 1.4% for JCS 0 in 2015. In the analysis of subjects with severe JCS 3 digit, years (OR = 0.97, 95% CI = 0.94 - 1.00), CSC score increase (0.98, 95% CI = 0.97 - 0.99), and tPA or endovascular thrombectomy (OR = 0.75, 95% CI = 0.67 - 0.84) were found to reduce the risk of death.Conclusion: According to the analysis of patients with acute ischemic stroke for 5 years, tPA or endovascular thrombectomy was related to reduced mortality in subjects with high severity.