Influence of atrial fibrillation on outcome after intravenous thrombolysis for acute ischemic stroke

Abstract

Objective To investigate the influences of atrial fibrillation (AF) on clinical outcome and hemorrhagic transformation (HT) after intravenous thrombolysis for acute ischemic stroke. Methods The patients with acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator thrombolysis were enrolled retrospectively. The modified Rankin Scale score 0-2 at 90 d was defined as a good outcome. Multivariate logistic regression analysis was used to determine the correlation between AF and clinical outcomes after intravenous thrombolysis. Results A total of 160 patients with acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator thrombolysis were enrolled, including 67 (41.88%) with AF. Compared with the non-AF group, the age was older (median [interquartile range] 77 [71-83] years vs. 69 [59-78] years; Z=4.142, P<0.001), baseline National Institutes of Health Stroke Scale (NHISS) score was higher (11.0[6.0-17.0] vs. 7.0[4.0-14.0]; Z=2.623, P=0.009) in the AF group. There were no significant differences in the NIHSS score reduction and the proportion of patients with good outcomes at 24 h (3.0[1.0-4.5] vs. 2.0[0-6.0]; Z= -0.312, P=0.775) and 7 d (4.0 [2.0-5.0] vs. 5.0[2.0-8.0]; Z=1.574, P=0.115) after thrombolysis and the proportion of patients with good outcome at 90 d (38.81% vs. 25.82%; χ2=3.063, P=0.080) between the AF group and the non-AF group, however, the proportions of HT within 24 h (14.93% vs. 5.38%; χ2=4.179, P=0.041) and death within 90 days (16.42% vs. 6.45%; χ2=4.073, P=0.044) in the AF group were significantly higher than those in the non-AF group. Multivariate logistic regression analysis showed that AF was not independent correlation with the clinical outcomes at 90 d (odds ratio [OR] 0.950, 95% confidence interval [CI] 0.381-2.366; P=0.912), HT within 24 h (OR 1.992, 95% CI 0.580-6.369; P=0.285), and death within 90 d (OR 2.483, 95% CI 0.727-8.586; P=0.146). Conclusion AF is not the independent risk factor that influences on clinical outcome at 90 d and HT within 24 h after intravenous thrombolysis in patients with acute ischemic stroke. Key words: Stroke; Brain Ischemia; Atrial Fibrillation; Thrombolytic Therapy; Tissue Plasminogen Activator; Treatment Outcome; Cerebral Hemorrhage; Risk Factors