Relationship Between Chronic Atrial Fibrillation and Worse Outcomes in Stroke Patients After Intravenous Thrombolysis
Relationship Between Chronic Atrial Fibrillation and Worse Outcomes in Stroke Patients After Intravenous Thrombolysis
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DOI：
10.1001/archneurol.2011.248
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发表时间：
2011-11-01
影响因子：
--
通讯作者：
Rabinstein, Alejandro A.
中科院分区：
文献类型：
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作者：
Seet, Raymond C. S.;Zhang, Yi;Rabinstein, Alejandro A.
背景资料：目前尚不清楚伴有心房颤动（AF）的卒中患者静脉注射重组组织型纤溶酶原激活剂后是否容易出现不良结局，以及AF的负担是否影响这些结局。目的：探讨AF对卒中患者的影响。静脉注射重组组织型纤溶酶原激活剂治疗的患者中，房颤（无论是首次检测到的房颤发作还是慢性房颤）与卒中结局的关系。回顾性研究。设置：学术性医院。患者：急性缺血性卒中的连续性患者，在症状发作后3小时内接受静脉注射重组组织型纤溶酶原激活剂。比较有无AF患者的血管危险因素、卒中特征和结局指标。主要结局指标：症状性颅内出血和功能恢复差（改良兰金量表评分>2）。在接受研究的214名患者中，（平均[SD]年龄，74 [14]岁，50%的患者为男性），21例首次检测到AF发作，慢性房颤患者症状性颅内出血的发生率明显高于无房颤患者慢性房颤患者功能恢复不良的发生率显著高于无房颤患者（62% vs 44%）。在调整年龄和基线国立卫生研究院卒中量表评分后，慢性AF患者中症状性颅内出血（但功能恢复不佳）的风险增加仍然显著（比值比，2. 95 [95% CI，1. 12 - 9. 30]）。出现症状性颅内出血的慢性房颤患者的房颤持续时间比未出现症状性颅内出血的患者长（59 vs 23个月），功能恢复差的慢性房颤患者的房颤持续时间比未出现症状性颅内出血的患者长（36 vs 16个月）（P <0.05）。相比之下，首次检测到的AF发作的患者和没有AF的患者之间的结果没有差异，阵发性AF患者和持续性或永久性AF患者之间的结果没有差异。结论：慢性AF患者的卒中结局比没有AF的患者更差，AF持续时间较长的患者预后更差的风险更大。
Background: It is unclear whether stroke patients with atrial fibrillation (AF) are prone to adverse outcomes following treatment with intravenous recombinant tissue plasminogen activator, and whether the burden of AF affects these outcomes.Objective: To investigate the contribution of AF (whether it be a first-detected episode of AF or chronic AF) to stroke outcomes in patients treated with intravenous recombinant tissue plasminogen activator.Design: Retrospective study.Setting: Academic hospital.Patients: Consecutive patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator within 3 hours from symptom onset were included. Vascular risk factors, stroke characteristics, and outcome measures were compared between patients with and without AF.Main Outcome Measures: Symptomatic intracranial hemorrhage and poor functional recovery (modified Rankin Scale score of >2).Results: Of the 214 patients who were studied (mean [SD] age, 74 [14] years, with 50% of patients being men), 21 had a first-detected episode of AF, and 55 had chronic AF. The incidence of symptomatic intracranial hemorrhage was significantly higher in patients with chronic AF than in patients without AF (16% vs 5%), and the incidence of poor functional recovery was significantly higher in patients with chronic AF than in patients without AF (62% vs 44%). The increase in risk of symptomatic intracranial hemorrhage (but not in poor functional recovery) among patients with chronic AF remained significant after adjusting for age and baseline National Institutes of Health Stroke Scale score (odds ratio, 2.95 [95% CI, 1.12-9.30]). Patients with chronic AF who developed a symptomatic intracranial hemorrhage had a longer duration of AF than those who did not (59 vs 23 months), and patients with chronic AF who had a poor functional recovery had a longer duration of AF than those who did not (36 vs 16 months) (P < .05). By contrast, there were no differences in outcomes between patients with a first-detected episode of AF and those without AF, and between patients with paroxysmal AF and those with persistent or permanent AF.Conclusions: Patients with chronic AF have worse stroke outcomes than do patients without AF, and the risk for worse outcomes was greater in patients with a longer duration of AF.