The therapeutic effect and prognosis of acute cerebral infarction patients with atrial fibrillation treated by ntravenous thrombolysis with recombinant tissue plasminogen activator

Abstract

Objective To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in acute cerebral infarct patients with atrial fibrillation (AF) and the predicting factors of poor prognosis. Methods Totally 162 patients with acute cerebral infarct were treated with rt-PA within 4.5 hours from the onset.According to past history and the electrocardiogram，the patients was classified into AF (n=45) and non-AF (n=117) groups.The baseline National Institute of Health Stroke Scale (NIHSS) scores and Modified Rankin Scale (mRS) scores 3 months after onset were collected. Results (1) The mean age in AF group was higher than non-AF group (69.2±11.6 vs 62.5±12.9，t=-3.050，P=0.003)，the smoking rate was higher in non-AF group (6.7% (3/45) vs 28.2% (33/117)，χ2=8.723，P=0.003). Others had no statistically significance. (2) The baseline NIHSS scores was not significantly different between AF and non-AF group.There was no statistically significance in the rate of mRS 0-1 scores in the 2 groups after 3 months.The rate of hemorrhagic transformation (31.1% (14/45) vs 14.5% (17/117)，χ2=5.774，P=0.016) and mortality rate (26.7% (12/45) vs 12.0% (14/117)，χ2=5.213，P=0.022) was higher in AF group than non-AF group.But the rate of symptomatic intracranial hemorrhage was not significantly different between AF and non-AF group. (3) In All 45 patients with AF，the prognosis of 18 patients was well (mRS scores 0-1) while 27 patients were poor (mRS scores 2-5).The NIHSS scores in poor prognosis group was higher than good prognosis group (17.70±5.87 vs 11.22±5.14，t=3.809，P=0.000)，while systolic blood pressure in poor prognosis group was lower than good prognosis group (145.5±24.0 vs 164.9±21.0，t=-2.788，P=0.008). (4) Multivariate regression analysis suggests that AF (OR=1.380，95% CI 0.217-7.017，P=0.698) was not an independent risk factor for death after thrombolysis，but AF (OR=3.558，95% CI 1.246-10.158，P=0.018) was an independent risk factor for intracerebral hemorrhage. Conclusions The presence of AF doesn’t affect the 3 months mRS of the acute cerebral nfarct patients after the intravenous thrombolysis.There are higher rate of hemorrhagic transformation and mortality in AF patient.But AF is not an independent risk factor of death while it doesn’t increased the risk of symptomatic intracranial hemorrhage.High NIHSS scores and low systolic blood pressure are risk factor of poor prognosis or even death in AF patients after thrombolytic therapy. Key words: Atrial fibrillation; Brain ischemia; Stroke; Tissue plasminogen activator; Thrombolytic therapy; Prognosis