Is atrial fibrillation associated with poor outcome after thrombolysis?
- 189 Downloads
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.
KeywordsIschemic stroke Atrial fibrillation Intravenous thrombolysis MRI Clinical outcome
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.
- 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
- 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
- 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