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.
Similar content being viewed by others
References
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 155:469–473
Wolf PA, Abbott RD, Kannel WB (1987) Atrial fibrillation: a major contributor to stroke in the elderly: the Framingham study. Arch Intern Med 147:1561–1564
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 18:47–56
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 38:2935–2940
Haft JI, Teichholz LE (2008) Echocardiographic and clinical risk factors for atrial fibrillation in hypertensive patients with ischemic stroke. Am J Cardiol 102:1348–1351
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 76:679–683
The National Institute of Neurological Disorders, stroke rt-PA stroke study group (1995) Tissue plasminogen activator for acute ischemic stroke. New Eng J Med 333:1581–1587
Hacke W, Kaste M, Bluhmki E et al (2008) Thrombolysis with alteplase 3–4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329
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 31:1812–1816
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 33:1301–1307
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 267:57–61
Brown DL, Johnston KC, Wagner DP, Haley EC Jr (2004) Predicting major neurological improvement with intravenous recombinant tissue plasminogen activator treatment of stroke. Stroke 35:147–150
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 55:952–959
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 48:632–639
Hacke W, Kaste M, Bogousslavsky J et al (2003) European stroke initiative recommendations for stroke management-update 2003. Cerebrovasc Dis 16:311–337
The European Stroke Organisation (ESO) Executive Committee, the ESO Writing Committee (2008) Guidelines for management of ischemic stroke and transient ischaemic attack. Cerebrovasc Dis 25:457–507
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 352:1245–1251
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 276:6–8
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 35:151–156
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 35:1340–1344
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 26:1789–1797
Bang OY, Saver JL, Buck BH et al (2008) Impact of collateral flow on tissue fate in acute ischaemic stroke. J Neurol Neurosurg Psychiatry 79:625–629
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 98:476–484
Neuberger H-R, Mewis Ch, van Veldhuisen DJ (2007) Management of atrial fibrillation in patients with heart failure. Eur Heart J 28:2568–2577
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 32:695–703
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 8:591–598
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 107:2920–2925
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 39:3316–3322
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Šaňák, D., Herzig, R., Král, M. et al. Is atrial fibrillation associated with poor outcome after thrombolysis?. J Neurol 257, 999–1003 (2010). https://doi.org/10.1007/s00415-010-5452-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-010-5452-4