Does Atrial Fibrillation Worsen Stroke Outcomes in Acute Ischemic Stroke Treated with rt-PA?
Vorasoot N, MD1,2, Khempet W, MD1,2, Kongbunkiat K, MD1,2, Kasemsap N, MD1,2, Tiamkao S, MD1,2, Sawanyawisuth K, MD, PhD1,3
Affiliation : 1 Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 2 North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand 3 Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Research and Training Center for Enhancing Quality of Life of Working Age People, and Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand
Atrial fibrillation (AF) has been shown to worsen clinical outcomes in stroke patients. However, data of stroke outcomes and AF in Thai patients received a recombinant tissue plasminogen activator (rt-PA) are limited. This study was a descriptive retrospective study and conducted at Srinagarind Hospital of Khon Kaen University and other six hospitals in northeastern Thailand. The study period was between May 1, 2008 and April 30, 2013. The inclusion criteria included adult patients diagnosed with acute ischemic stroke who received rt-PA treatment. All eligible patients were divided into two groups by presence of AF. The stroke outcomes included the NIH Stroke Scale (NIHSS), modified Rankin scale (mRS), side effects of rt-PA, complications from stroke, and deaths. All outcomes were evaluated at discharge date. There were 768 patients for the analysis; 177 patients (23.04%) had AF. The AF group had more patients with severe or NIHSS more than 16 than the non-AF group (50.57% vs. 24.23%; p-value <0.001). Regarding stroke outcomes, the AF group had fewer patients with favorable clinical outcomes than those without stroke (34.45% vs. 57.88%; p-value <0.001), and had higher rate of intracerebral hemorrhage (23.73% vs. 9.60%; p-value <0.001) than the non-AF group. There was no significant mortality rate between both groups. In conclusion, Thai acute ischemic stroke with AF were more severe and had worse outcomes than those without AF despite the rt-PA treatment.
Keywords : Complications, Atrial fibrillation, NIHSS
