Abstract
Background and objectiveThe effect of atrial fibrillation (AF) on outcomes of endovascular treatment (EVT) for acute ischemic stroke (AIS) is controversial. This study aimed to investigate the association of AF with outcomes after EVT in AIS patients.MethodsSubjects were selected from ANGEL-ACT registry (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke) - a prospective consecutive cohort of AIS patients undergoing EVT at 111 hospitals in China between November 2017 and March 2019, and then grouped according to having a history of AF or not. After 1:1 propensity score matching, the outcome measures including the 90-day modified Rankin Scale (mRS) score, successful recanalization after final attempt, symptomatic intracranial hemorrhage (ICH) within 24 h, and death within 90 days were compared.ResultsA total of 1755 patients, 550 with AF and 1205 without AF, were included. Among 407 pairs of patients identified after matching, no significant differences were found in the mRS score (median: 3 vs. 3 points; P = 0.29), successful recanalization (87.2 vs. 85.3%; P = 0.42), symptomatic ICH (9. 4 vs. 9.1%; P = 0.86) and death (16.3 vs. 18.4%; P = 0.44) between patients with and without AF.ConclusionThe findings of this matched-control study show comparable outcomes of EVT in Chinese AIS patients with and without AF, which do not support withholding EVT in patients with both AIS and AF.Trial registrationNCT03370939First registration date: 28/09/2017First posted date: 13/12/2017
Highlights
Atrial fibrillation (AF), as the most common cause of cardioembolic stroke, is associated with a 4-5 times increased risk of acute ischemic stroke (AIS) and accounts for approximately 30–40% of all acute large vessel occlusion (LVO) [1,2,3,4,5,6,7,8]
Study population Data were extracted from ANGEL-ACT (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke), a prospective nationwide registry of 1793 consecutive patients with AIS caused by LVO undergoing endovascular treatment (EVT) in 111 hospitals in China between November 2017 and March 2019
Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) demonstrated no interaction between atrial fibrillation (AF) and functional outcomes after EVT, but found a trend towards a lower rate of symptomatic intracranial hemorrhage (ICH) in AIS patients with AF (3.4% in AF patients vs. 4.5% in nonAF patients), which might be related to the lower percentage of pre-treatment with intravenous thrombolysis (IVT) (76.3% in AF patients vs. 90.6% in non-AF patients)
Summary
Atrial fibrillation (AF), as the most common cause of cardioembolic stroke, is associated with a 4-5 times increased risk of acute ischemic stroke (AIS) and accounts for approximately 30–40% of all acute large vessel occlusion (LVO) [1,2,3,4,5,6,7,8]. Limited data and conflicting results exist regarding the role of AF on procedural and clinical outcomes after EVT [16,17,18,19,20,21] To address this issue and on the hypothesis that the modification of AF was attributed to the effect of case mix; in other words, AF might not independently affect any outcome in EVT-treated patients after adjusting for possible confounders. This study aimed to investigate the association of AF with outcomes after EVT in AIS patients
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