Abstract TMP75: Atrial Fibrillation In Ischemic Stroke: Predicting Response To Thrombolysis And Clinical Outcomes
Background: Atrial fibrillation (AF) increases the risk of stroke and is associated with poorer stroke outcomes. Few tools are available to evaluate clinical outcomes and response to thrombolysis in stroke patients with AF.
Methods: We applied the iScore (www.sorcan.ca/iscore), a validated risk score, to consecutive patients with an acute ischemic stroke participating in the RCSN. The main outcome was the proportion of patients with a favorable outcome (defined as a modified Rankin scale 0-2) at discharge after thrombolysis. Secondary outcomes included death at 30-days and at 1-year stratified by terciles of the iScore.
Results: Among 12,686 patients with an acute ischemic stroke, 2,185 (17.2%) had AF. Among patients in the highest iScore tercile, those with AF had higher mortality at 30 days (34.7% vs.28.2%; p<.001) and at 1-year (53.6% vs.45.0%; p3) at discharge (RR 1.26, 95%CI 1.18-1.33; Figure 1) and an increased risk of intracranial hemorrhage (any type) (16.5% vs. 13.1%; RR 1.42, 95%CI 1.05-1.91) after thrombolysis. In the Poisson regression analysis, the benefit of tPA declined more rapidly at lower iScore values among AF patients than for others (p-value for interaction <0.001; Figure 2).
Conclusion: The iScore predicted a differential response after tPA between patients with and without AF. Stroke patients with AF have higher mortality, greater risk of ICH, and reduced response to thrombolysis compared with non-AF patients for a given high iScore.
- © 2012 by American Heart Association, Inc.