Atrial fibrillation is associated with poor long-term outcome after mechanical thrombectomy for anterior large vessel occlusion stroke.

OBJECTIVES: Atrial fibrillation (AF) is one of the leading causes of acute ischemic stroke (AIS). The aim of our study was to determine the influence of AF on the long-term outcome of patients with AIS due to anterior circulation large vessel occlusion (LVO) treated with mechanical thrombectomy (MT). METHODS: Our study included 127 consecutive patients with AIS due to anterior LVO who underwent MT between January 2018 and March 2020. Demographics, clinical, radiological and treatment characteristics were prospectively collected. Modified Rankin scale (mRS) score ≤2 was defined as a good functional outcome. RESULTS: AF was detected in 62 (48.8%) patients. Patients with AF were elder (73.1 ± 8.7 vs. 58.5 ± 14.2 years, p<0.01) and usually female (56.5% vs. 36.9%, p=0.03). They had a lower percentage of good functional outcome (31.6% vs. 62.3%, p<0.01) and a higher mortality rate (47.5% vs. 18.5%, p<0.01) after one year of follow-up. In the multivariate logistic regression the variables that showed significance with p <0.05 in previous univariate analyses were included. The presence of AF (aOR 0.29, 95% CI 0.11-0.78, p=0.01) and initial NIHSS score >15 (aOR 0.25, 95% CI 0.11-0.56, p<0.01) were independent negative predictors of good functional outcome after one year of follow-up. However, the presence of AF did not affect all-cause mortality within one year (p=0.18). CONCLUSION: AF and initial NIHSS score >15 are independent negative predictors of good long-term functional outcome in patients with AIS due to anterior circulation LVO treated with MT.

Long-Term Prognosis in Ischemic Stroke Patients Treated with Intravenous Thrombolytic Therapy.

BACKGROUND AND PURPOSE: It remains unclear if intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator has an impact on the survival and maintenance of a favorable effect on functional recovery over a long follow-up period. The aim of this study was to assess whether or not IVT treatment has a favorable effect on functional recovery and survival less than 1 year after a stroke. METHODS: This matched cohort study included 259 patients with acute ischemic stroke (IS) who were treated with IVT and standard care and 259 patients treated with standard care alone in the stroke unit between February 2006 and January 2013. RESULTS: After a median follow-up period of 3 years (range, 1-7 years), survival did not differ significantly between the groups; specifically, 56 patients (21.6%) in the thrombolysed group died versus 62 patients (23.94%) in the nonthrombolysed group (log-rank, .240, P = .624). Based on a multivariate Cox proportional hazards regression model, older age (>70 years), stroke severity (National Institutes of Health Stroke Scale score ≥ 15), diabetes mellitus, and a history of atrial fibrillation were independent predictors of long-term mortality after stroke. After the follow-up period, 144 patients (55.6%) in the IVT-treated group versus 112 patients (43.2%) in the control group had an excellent outcome, with a modified Rankin Scale score of 0-1 (hazard ratio [HR] = 1.64, 95% confidence interval [CI] = 1.16-2.32). Based on a multivariate Cox proportional hazards regression model, an excellent 3-month functional recovery was a strong predictor of favorable outcome (HR = 11.27, 95% CI = 6.45-19.63). CONCLUSION: The results suggest that IVT for acute IS has a favorable effect on functional recovery more than 1 year after stroke.

Return to Paid Work after Ischemic Stroke in Patients Treated with Intravenous Thrombolysis.

BACKGROUND: There are no available data confirming the efficacy of intravenous thrombolytic (IVT) treatment on the return to work as one of important outcome measure after acute ischemic stroke (IS). The aim of this study was to analyze the influence of IVT treatment on the return to work after stroke. METHODS: This matched cohort study included 279 patients with acute IS (146 treated with IVT and 133 matched patients without IVT) admitted to the Stroke Unit between 2007 and 2013. All patients were working in paid employment immediately before stroke onset. The main outcome measure was return to full-time paid work during follow-up period. RESULTS: After a median follow-up period of 3 years (range 1-7 years), the prevalence of stroke survivors returning to paid work was 42.1% in the IVT group and 33.3% in the non-IVT group (hazard ratio 1.28, 95% CI 0.86-1.91), and IVT treatment was associated with a higher chance of returning to full-time jobs (OR 2.07, 95% CI 1.21-3.51). After adjustment for possible variables, IVT was an independent predictor of returning to full-time jobs. CONCLUSION: IVT treatment was a positive predictor of returning to full-time work after stroke.

Effect of intravenous thrombolysis on stroke associated with atrial fibrillation.

BACKGROUND: Data based on randomized clinical trials regarding the efficacy and safety of intravenous thrombolysis (IVT) versus placebo or any other antithrombotic agent in the treatment of stroke associated with atrial fibrillation (AF) are unavailable. METHODS: Prospectively collected data on AF-associated stroke patients treated in a 3-year period were analyzed to assess the effect of IVT treatment. Outcome measures were modified Rankin Scale (mRS) score for functional outcome, death, and symptomatic intracerebral hemorrhage (sICH). RESULTS: Of 787 patients diagnosed with an acute ischemic stroke in the observed period, 131 (16.6%) had AF. Multivariate logistic regression analysis after adjustment for confounders demonstrated that independent predictors of excellent outcome (mRS 0-1) in patients with AF-associated stroke were lower baseline National Institutes of Health Stroke Scale [NIHSS] score (adjusted odds ratio [(adj)OR], .87; 95% confidence interval [CI], 0.81-.94; P = .000) and the use of IVT ((adj)OR, 5.31; 95% CI, 1.90-14.82; P = .001), whereas independent predictors of death were higher baseline NIHSS score ((adj)OR, 1.07; 95% CI, 1.02-1.12; P = .003), previous stroke ((adj)OR, 4.11; 95% CI, 1.49-11.35; P = .006), absence of IVT use ((adj)OR, .19; 95% CI, .05-.77; P = .021), sICH ((adj)OR, 18.52; 95% CI, 1.59-215.37; P = .020), and higher serum glucose levels ((adj)OR, 1.26; 95% CI, 1.06-1.50; P = .008). Thrombolyzed patients with AF were less severe at baseline and were less likely to have NIHSS >18. They were more likely to have excellent and good functional outcome (mRS 0-2) whereas less likely to have death as outcome at 3 months. Thrombolyzed AF patients had constantly lower probability of death regardless of the baseline NIHSS score values. CONCLUSIONS: These results should encourage the use of IVT in AF-associated strokes.

The frequency of poststroke infections and their impact on early stroke outcome.

INTRODUCTION: Poststroke infections are the most common medical complications of stroke and can occur in up to 65% of patients. The aim of this study was to assess the rate of infectious complications during hospitalization of stroke patients and to evaluate the impact of infection in general, including each of the urinary tract infection (UTI), pneumonia, and sepsis, on fatal and poor functional outcome at discharge. METHODS: This retrospective study enrolled patients who have been diagnosed with acute ischemic stroke treated in a 1-year period. Poor functional outcome at discharge was defined as severe invalidity and included patients with modified Rankin Scale score of 3-5. Univariate and multivariate analyses were performed. RESULTS: We analyzed 133 patients with acute ischemic stroke. Poststroke infection occurred in 63 (47.4%) patients. The most common infection was UTI that was present in 27 (20.3%) patients. Multivariate logistic regression analysis after adjustment for confounders demonstrated that poststroke infection was an independent predictor of poor functional outcome (odds ratio [OR] 12.82, 95% confidence interval [CI] 4.09-40.0, P < .001) and death at discharge (OR 14.92, 95% CI 2.97-76.92, P = .001). When analyzing the impact of each infectious complication, multivariate logistic regression showed that UTIs were an independent predictor of poor functional outcome (OR 14.08, 95% CI 3.06-64.84, P = .001) and death (OR 9.81, 95% CI 1.46-65.68, P = .019) at discharge. CONCLUSION: Infection is a frequent poststroke complication and represents an independent predictor of poor functional and fatal early stroke outcome.