Revascularisation therapies improve the outcomes of ischemic stroke patients with atrial fibrillation and heart failure

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:324

Article

Pana, Tiberiu A.^1,2  Mohamed, Mohamed O.¹  Clark, Allan B.³  Fahy, Eoin¹  Mamas, Mamas A.¹  Myint, Phyok.^1,2,3 

[1] Keele Univ, Inst Primary Care & Hlth Sci, Ctr Prognosis Res, Keele Cardiovasc Res Grp, Stoke On Trent, Staffs, England

[2] Univ Aberdeen, Sch Med Med Sci & Nutr, Inst Appl Hlth Sci, Aberdeen, Scotland

[3] Univ East Anglia, Norwich Med Sch, Norwich, Norfolk, England

关键词: Atrial fibrillation;    Heart failure;    Cerebrovascular disease;    Stroke;    Thrombolysis;    Thrombectomy;   

DOI  :  10.1016/j.ijcard.2020.09.076

来源: Elsevier

【 摘 要 】

Background: Atrial fibrillation (AF) and heart failure (HF) carry a poor prognosis in acute ischaemic stroke (AIS). The impact of revascularisation therapies on outcomes in these patients is not fully understood. Method: National Inpatient Sample (NIS) AIS admissions (January 2004-September 2015) were included (n = 4,597,428). Logistic regressions analysed the relationship between exposures (neither AF nor HF-reference, AF-only, HF-only, AF + HF) and outcomes (in-hospital mortality, length-of-stay >median and moderate-to-severe disability on discharge), stratifying by receipt of intravenous thrombolysis (IVT) or endovascular thrombectomy (ET). Results: 69.2% patients had neither AF nor HF, 16.5% had AF-only, 7.5% had HF-only and 6.7% had AF + HF. 5.04% and 0.72% patients underwent IVT and/or ET, respectively. AF-only and HF-only were each associated with 75-85% increase in the odds of in-hospital mortality. AF + HF was associated with greater than two-fold increase in mortality. Patients with AF-only, HF-only or AF + HF undergoing IVT had better or at least similar in-hospital outcomes compared to their counterparts not undergoing IVT, except for prolonged hospitalisation. Patients undergoing ET with AF-only, HF-only or AF + HF had better (in-hospital mortality, discharge disability, all-cause bleeding) or at least similar (length-of-stay) outcomes to their counterparts not undergoing ET. Compared to AIS patients without AF, AF patients had approximately 50% and more than two-fold increases in the likelihood of receiving IVT or ET, respectively. Conclusions: We confirmed the combined and individual impact of co-existing AF or HF on important patient-related outcomes. Revascularisation therapies improve these outcomes significantly in patients with these comorbidities. (C) 2020 Elsevier B.V. All rights reserved.

【 授权许可】

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