AF an Independent Risk Factor for Poor Outcomes in Ischemic Stroke

Tanyatorn Ghanjanasak, DO, for Medscape

October 04, 2022

The study covered in this summary was published on ResearchSquare.com as a preprint and has not yet been peer reviewed.

Key Takeaways

  • The study reported that atrial fibrillation (AF) was an independent risk factor for poor clinical outcomes among patients with severe ischemic stroke (IS).

  • AF was significantly associated with higher hospital admission and discharge National Institute of Health Stroke Scale (NIHSS) scores, longer hospital stays, higher inpatient mortality rates, and higher hospitalization costs.

Why This Matters

  • The present study demonstrated that AF is an independent risk factor for severe ischemic stroke (NIHSS ≥ 16) and in-hospital death.

  • Treatment of cardiovascular diseases could improve the prognosis of IS patients.

Study Design

  • The study was a retrospective analysis of AF and non-AF patients with acute IS at Shanghai Sixth People's Hospital from January 2017 to January 2018.

  • Inclusion criteria were age 18 years or older and IS within 2 weeks of onset.

  • Patients with diagnoses of transient ischemic attack, lacunar cerebral infarction, valvular AF, severe liver dysfunction, kidney diseases, or malignant tumors were excluded. Patients without cranial CT or MRI within 2 weeks of clinical symptoms were also excluded.

  • All patients who met study criteria received cranial CT or MRI within 2 weeks of the onset of clinical symptoms and were evaluated for stroke severity using the NIHSS score.

  • Multivariate logistic regression was used to determine the association of AF with stroke severity and in-hospital death.

  • A propensity score–matched analysis was used to estimate differences in severity and infarct volume between patients with and those without AF.

Key Results

  • The study cohort included 586 patients.

  • In the AF group, the median age of the patients (n = 103) was 80 years, and 103 were women.

  • In the non-AF group, the median age of the patients (n = 396) was 68 years, and 183 were women.

  • Patients in the AF group were found to have significantly (P < .0001) higher admission and discharge NIHSS scores (median, 11 vs 3 and 7 vs 2, respectively), longer hospital stays (median, 11 days vs 10 days; P = .001), higher in-hospital mortality rate (24.2% vs 4.8%), and higher hospitalization costs compared with the non-AF group.

  • Multivariate logistic regression analyses found that AF was an independent risk factor for severe stroke (NIHSS score ≥16) and inpatient death.

  • After propensity score matching, patients in the AF group were found to have greater infarct volume (25.8 mL [7.9–83.8] vs 1.4 mL [0.7–9.5]; P < .0001).

Limitations

  • The study was a single-center observational study with a small sample size with patient selection biases.

  • Paroxysmal AF capture might be inadequate with electrocardiogram, dynamic electrocardiogram, or cardiac monitoring and the monitoring time window.

  • Interval of neurologic change to completion of brain MRI might be varied due to patients with advanced age in the study population

Disclosures

  • The study was supported by grants from the National Nature Science Foundation of China, Municipal Science and Technology Commission Medical Innovation Project, the 14th undergraduate training program for innovation of Shanghai Jiao Tong University school of medicine to Dong Huang, MD, the Interdisciplinary Program of Shanghai Jiao Tong University, Natural Science Foundation of Shanghai, and the National Nature Science Foundation of China to Jingbo Li, MD.

  • The authors have disclosed no relevant financial relaitonships.

This is a summary of a preprint research study, "An In-Depth Analysis of the Clinical Outcome of Ischemic Stroke Patients With Atrial Fibrillation," written by Fenghua Fan of the Tongji University in Shanghai, China, and colleagues, published on ResearchSquare.com and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on ResearchSquare.com.

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