Abstract P15: Does Atrial Fibrillation Impact 90-Day Outcome in Acute Ischemic Stroke Patients Treated With rt-PA and/or Endovascular Treatment?

Abstract

Background: Patients with acute ischemic stroke (AIS) due to atrial fibrillation (a fib) may not have as favourable of a response to intravenous thrombolysis or endovascular treatment (ET) compared to other stroke subtypes. The purpose of this study was to compare the 90-day outcome in patients with and without a history of a fib treated with IV rt-PA and/or ET. Method: Consecutive stroke code activations were retrospectively analyzed from January 2004-June 2020 at an academic comprehensive stroke center. Patients were included if they were treated with IV rt-PA and/or ET within 24 hours of stroke onset. Patients were stratified into the six groups: 1- No history of a fib with ET only, 2- History of a fib with ET only, 3- No history of a fib with IV rt-PA plus ET, 4- History of a fib with IV rt-PA plus ET, 5- No history of a fib with IV rt-PA only, 6- History of a fib with IV rt-PA only. Primary outcome was 90 day modified Rankin Scale (mRS) with favourable outcome defined as mRS 0-2. Baseline demographics were compared and pairwise Wilcoxon Rank was used to assess group differences followed by multinomial regression. Analyses were both unadjusted and adjusted for baseline NIHSS, age, sex, baseline blood pressure, pre-stroke mRS, smoking status, and baseline glucose. Results: We identified 720 AIS patients who received acute treatment (IV rt-PA: n=578; ET: n=100; IV rt-PA+ET:n=18). There was a significant difference in sex (p=0.005); Hispanic ethnicity (p=0.002); current smoking (p=<0.001); current alcohol use (p=0.03), CHF (p=0.01); and age (p<0.0001) between groups. Baseline NIHSS was significantly higher in Group 4 (23, SD 8, p=<0.001). In adjusted analysis, there were significantly more patients with mRS 1 (p=0.03) and mRS 2 (p=0.01) in Group 5 compared to group 6. There was no significant difference in “favourable outcome” in adjusted analyses both between groups and in patients with and without afib overall (OR: 3.10, 95% CI: 0.19-50.97, p=0.43). Conclusion: In this study, afib did not have a significant impact on 90-day outcome in AIS patients treated with IV rt-PA, ET, or both. This study supports the acute use of IV rt-PA in the atrial fibrillation population despite anecdotal comments that cardioembolic strokes do not improve with thrombolysis.