Outcomes of ischemic stroke in patients with atrial fibrillation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients with atrial fibrillation (AF) have higher risk of ischemic stroke. Purpose We investigated whether AF patients experiencing an ischemic stroke have worse outcomes. Methods AF patients admitted to the stroke unit from 2018 to 2021 were included. The NIHSS and the modified Rankin Scale (mRS) score were calculated at the admission and at discharge. The neurological improvement was calculated as delta NIHSS (NIHSS at admission - NIHSS at discharge =Δdis). Results Six-hundred patients (45% men), mean age 69±13 years. Of these 75 had previous history of atrial fibrillation (AF) and 86 had AF during the hospitalization (46 both). Overall 115 had one of the two. Patients with AF had higher NIHSSad (14.5±7 vs 9.6±7; p<0.001) and NIHSS24 (10.4±8 vs 7.2±7; p<0.001) than patients without, however the neurological improvement was greater (Δdis -8.4±8 vs -5.1±6; p=0.004), indeed the NIHSSdis was similar (5.6±7 vs 4.1±6; p=0.1). Patients with AF also had a more impaired mRS before the ischemic event and at discharge (1.34±1.3 vs 0.58±1.1, p<0.001; 2.6±1.7 vs 1.8±1.9, p=0.005). Amongst AF patients with CHADVASC³2 in men and ³3 in women, 36% of them were taking antiplatelet therapy, 35% anticoagulants and 29% didn’t take any therapy. Of interest, no differences in the NIHSSad nor in the NIHSSdis were found between them and neither in the Δdis. As for the treatment of AF patients, patients who underwent to mechanical thrombectomy (MT) had higher NIHSSad (17± 5) compared to patients receiving intravenous thrombolysis (IV) or nothing (11± 7 and 12± 8) (p<0.001). The NIHSSdis was similar between the three groups however the Δdis was significantly higher in patients treated with mechanical thrombectomy (-12.5±6 vs 3.6±4; vs 3.1±8; p=0.003 and p<0.001 respectively). Conclusions Patients with AF experience more severe stroke, however the neurological recovery is greater than in patients without the arrhythmia. The treatment with antiplatelets or anticoagulants before the event does not reduce the severity of the stroke and does not influence the improvement of the NIHSS at discharge. The mechanical thrombectomy is more effective in reducing the neurological impairment.