Advertisement

Journal of Neurology

, Volume 257, Issue 6, pp 999–1003 | Cite as

Is atrial fibrillation associated with poor outcome after thrombolysis?

  • Daniel Šaňák
  • Roman Herzig
  • Michal Král
  • Andrea Bártková
  • Jana Zapletalová
  • Martin Hutyra
  • David Školoudík
  • Ivanka Vlachová
  • Tomáš Veverka
  • David Horák
  • Petr Kaňovský
Original Communication

Abstract

Atrial fibrillation (AF) is considered a predictor for severe stroke and poor outcome. The aim was to evaluate whether AF is associated with poor outcome in acute ischemic stroke (IS) patients treated with intravenous thrombolysis (IVT). In a retrospective study, 157 consecutive IS patients (98 males, mean age 67.3 ± 10.2 years), treated with IVT within 3 hours from stroke onset, were divided into two groups according to presence/absence of AF. Neurological deficit was evaluated using the NIHSS on admission, 24 hours, and 7 days later, while the 90-day clinical outcome was assessed using the modified Rankin Scale (mRS). A total of 66 patients (38 males) presented with AF. The baseline NIHSS was 13.3 ± 5.4 in AF and 11.0 ± 5.1 points in non-AF patients (P = 0.006). AF patients had arterial occlusions more frequently in the baseline MRA (54.5% in AF versus 25.3% in non-AF, P = 0.0002). No differences were found between groups in clinical improvement after 24 hours and 7 days or in rate of achieved recanalizations. AF patients had significantly poorer 90-day clinical outcome than non-AF patients (median mRS 2.5 vs. 1.0). Patients with AF had significantly worse 90-day clinical outcome after IVT compared to those without AF, probably due to more severe baseline neurological deficits and the greater number of arterial occlusions in the MRA before IVT.

Keywords

Ischemic stroke Atrial fibrillation Intravenous thrombolysis MRI Clinical outcome 

Notes

Acknowledgment

The study was supported in part by the IGA Ministry of Health, the Czech Republic, grant number NR/8579-3/2005 and by a grant project of the Ministry of Education, the Czech Republic, number MSM 6198959216.

References

  1. 1.
    Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG (1995) Prevalence, age distribution, and gender of patients with atrial fibrillation: analysis and implications. Arch Intern Med 155:469–473CrossRefPubMedGoogle Scholar
  2. 2.
    Wolf PA, Abbott RD, Kannel WB (1987) Atrial fibrillation: a major contributor to stroke in the elderly: the Framingham study. Arch Intern Med 147:1561–1564CrossRefPubMedGoogle Scholar
  3. 3.
    Kimura K, Kazui S, Minematsu K, Yamaguchi T (2004) Analysis of 16,922 patients with acute ischemic stroke and transient ischemic attack in Japan: a hospital-based prospective registration study. Cerebrovasc Dis 18:47–56CrossRefPubMedGoogle Scholar
  4. 4.
    Liao J, Zahira K, Scallan C, Morillo C, O’Donnell M (2007) Noninvasive cardiac monitoring for detecting paroxysmal atrial fibrillation or flutter after acute ischemic stroke: a systematic review. Stroke 38:2935–2940CrossRefPubMedGoogle Scholar
  5. 5.
    Haft JI, Teichholz LE (2008) Echocardiographic and clinical risk factors for atrial fibrillation in hypertensive patients with ischemic stroke. Am J Cardiol 102:1348–1351CrossRefPubMedGoogle Scholar
  6. 6.
    Kimura K, Minematsu K, Yamaguchi T (2005) Atrial fibrillation as a predictive factor for severe stroke and early death in 15,831 patients with acute ischaemic stroke. J Neurol Neurosurg Psychiatry 76:679–683CrossRefPubMedGoogle Scholar
  7. 7.
    The National Institute of Neurological Disorders, stroke rt-PA stroke study group (1995) Tissue plasminogen activator for acute ischemic stroke. New Eng J Med 333:1581–1587CrossRefGoogle Scholar
  8. 8.
    Hacke W, Kaste M, Bluhmki E et al (2008) Thrombolysis with alteplase 3–4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329CrossRefPubMedGoogle Scholar
  9. 9.
    Christou I, Alexandrov AV, Burgin WS et al (2003) Timing of recanalization after tissue plasminogen activator therapy determined by transcranial Doppler correlates with clinical recovery from ischemic stroke. Stroke 31:1812–1816Google Scholar
  10. 10.
    Felberg RA, Okon NJ, El-Mitwalli A, Burgin WS, Grotta JC, Alexandrov AV (2002) Early dramatic recovery during intravenous tissue plasminogen activator infusion: clinical pattern and outcome in acute middle cerebral artery stroke. Stroke 33:1301–1307CrossRefPubMedGoogle Scholar
  11. 11.
    Kimura K, Iguchi Y, Yamashita S, Shibazaki K, Kobayashi K, Inoue T (2008) Atrial fibrillation as an independent predictor for no early recanalization after IV-t-PA in acute ischemic stroke. J Neurol Sci 267:57–61CrossRefPubMedGoogle Scholar
  12. 12.
    Brown DL, Johnston KC, Wagner DP, Haley EC Jr (2004) Predicting major neurological improvement with intravenous recombinant tissue plasminogen activator treatment of stroke. Stroke 35:147–150CrossRefPubMedGoogle Scholar
  13. 13.
    Frankel MR, Morgenstern LB, Kwiatkowski T et al (2000) Predicting prognosis after stroke: a placebo group analysis from the national institute of neurological disorders and stroke rt-PA stroke trial. Neurology 55:952–959PubMedGoogle Scholar
  14. 14.
    Šaňák D, Nosáľ V, Horák D et al (2006) Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis. Neuroradiology 48:632–639CrossRefPubMedGoogle Scholar
  15. 15.
    Hacke W, Kaste M, Bogousslavsky J et al (2003) European stroke initiative recommendations for stroke management-update 2003. Cerebrovasc Dis 16:311–337CrossRefGoogle Scholar
  16. 16.
    The European Stroke Organisation (ESO) Executive Committee, the ESO Writing Committee (2008) Guidelines for management of ischemic stroke and transient ischaemic attack. Cerebrovasc Dis 25:457–507CrossRefGoogle Scholar
  17. 17.
    Hacke W, Kaste M, Fieschi C et al (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischemic stroke (ECASS II), Second European-Australasian Acute Stroke Study Investigators. Lancet 352:1245–1251CrossRefPubMedGoogle Scholar
  18. 18.
    Kimura K, Iguchi Y, Shibazaki K, Iwanaga T, Yamashita S, Aoki J (2009) IV t-PA therapy in acute stroke patients with atrial fibrillation. J Neurol Sci 276:6–8CrossRefPubMedGoogle Scholar
  19. 19.
    Molina CA, Alexandrov AV, Demchuk AM, Saqqur M, Uchino K, Alvarez-Sabin J (2004) Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator. Stroke 35:151–156CrossRefPubMedGoogle Scholar
  20. 20.
    Kim JJ, Fischbein NJ, Lu Y, Pham D, Dillon WP (2004) Regional angiographic grading system for collateral flow: correlation with cerebral infarction in patients with middle cerebral artery occlusion. Stroke 35:1340–1344CrossRefPubMedGoogle Scholar
  21. 21.
    Christoforidis GA, Mohammad Y, Kehagias D, Avutu B, Slivka AP (2005) Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke. Am J Neuroradiol 26:1789–1797PubMedGoogle Scholar
  22. 22.
    Bang OY, Saver JL, Buck BH et al (2008) Impact of collateral flow on tissue fate in acute ischaemic stroke. J Neurol Neurosurg Psychiatry 79:625–629CrossRefPubMedGoogle Scholar
  23. 23.
    Krahn AD, Manfreda J, Tate RB et al (1995) The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba follow-up study. Am J Med 98:476–484CrossRefPubMedGoogle Scholar
  24. 24.
    Neuberger H-R, Mewis Ch, van Veldhuisen DJ (2007) Management of atrial fibrillation in patients with heart failure. Eur Heart J 28:2568–2577CrossRefPubMedGoogle Scholar
  25. 25.
    Dries DL, Exner DV, Gersh BJ et al (1998) Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. J Am Coll Cardiol 32:695–703CrossRefPubMedGoogle Scholar
  26. 26.
    Kober L, Swedberg K, McMurray J et al (2006) Previously known and newly diagnosed atrial fibrillation: a major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction. Eur J Heart Fail 8:591–598CrossRefPubMedGoogle Scholar
  27. 27.
    Wang TJ, Larson MG, Levy D et al (2003) Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham heart study. Circulation 107:2920–2925CrossRefPubMedGoogle Scholar
  28. 28.
    Wahlgren N, Ahmed N, Eriksson N, Aichner F, Bluhmki E, Daválos A, Erilä T, Ford GA, Grond M, Hacke W, Hennerici MG, Kaste M, Köhrmann M, Larrue V, Lees KR, Machnig T, Roine RO, Toni D, Vanhooren G, for the SITS-MOST Investigators (2008) Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST). Stroke 39:3316–3322CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Daniel Šaňák
    • 1
  • Roman Herzig
    • 1
  • Michal Král
    • 1
  • Andrea Bártková
    • 1
  • Jana Zapletalová
    • 2
  • Martin Hutyra
    • 3
  • David Školoudík
    • 1
  • Ivanka Vlachová
    • 1
  • Tomáš Veverka
    • 1
  • David Horák
    • 4
  • Petr Kaňovský
    • 1
  1. 1.Stroke Center, Department of NeurologyPalacký University Medical School and University HospitalOlomoucCzech Republic
  2. 2.Department of Biometry and StatisticsPalacký University Medical SchoolOlomoucCzech Republic
  3. 3.Department of CardiologyPalacký University Medical School and University HospitalOlomoucCzech Republic
  4. 4.Department of RadiologyPalacký University Medical School and University HospitalOlomoucCzech Republic

Personalised recommendations