Does the presence of atrial fibrillation worsen 90-day functional outcomes and mortality in patients treated with mechanical thrombectomy for acute ischemic stroke?
Patients with atrial fibrillation undergoing mechanical thrombectomy for acute ischemic stroke have worse 90-day functional outcomes and higher mortality compared to those without AF, likely driven by older age and a higher burden of comorbidities.
Importance: Patients with atrial fibrillation (AF) treated with mechanical thrombectomy (MT) for acute ischemic stroke (AIS) have been reported to experience worse outcomes compared with patients without AF. Objective: To assess differences between patients with AF and their counterparts without AF treated with MT for AIS, focusing on safety outcomes, clinical outcomes, and baseline characteristics in both groups. Data Sources: A systematic literature review of the English language literature from inception to July 14, 2022, was conducted using Web of Science, Embase, Scopus, and PubMed databases. Study Selection: Studies that focused on patients with and without AF treated with MT for AIS were included. Multiple reviewers screened studies to identify studies included in analysis. Data Extraction and Synthesis: Data were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline to ensure accuracy. Data were pooled using a random-effects model. Main Outcomes and Measures: The primary outcome of interest was rate of modified Rankin Scale (mRS) scores of 0 to 2 at 90 days. Secondary outcomes of interest included rates of successful reperfusion, defined as thrombolysis in cerebral infarction (TICI) scores of 2b to 3, 90-day mortality, symptomatic intracranial hemorrhage (SICH), and baseline patient characteristics. Results: Of 1696 initially retrieved studies, 10 studies were included, with 6543 patients. Patients with AF were a mean of 10.17 (95% CI, 8.11-12.23) years older (P < .001) and had higher rates of hypertension (OR, 1.89 95% CI, 1.57-2.27; P < .001) and diabetes (OR, 1.16 95% CI, 1.02-1.31; P = .02). Overall, there were comparable rates of mRS scores of 0 to 2 between patients with AF and patients without AF (odds ratio OR, 0.72 95% CI, 0.47-1.10; P = .13), with significant heterogeneity among the included studies. After sensitivity analysis, the rate of mRS scores of 0 to 2 was significantly lower among patients with AF (OR, 0.65 95% CI, 0.52-0.81; P < .001). Successful reperfusion rates were similar between the groups (OR, 1.11 95% CI, 0.78-1.58; P = .57). The rate of SICH was similar between groups (OR, 1.05 95% CI, 0.84-1.31; P = .68). Mortality was significantly higher in the AF group (OR, 1.47 95% CI, 1.12-1.92; P = .005). Conclusions and Relevance: In this systematic review and meta-analysis, patients with AF experienced worse 90-day outcomes, even in the setting of similar rates of successful reperfusion. This was likely associated with greater age and greater rates of comorbidities among patients with AF.
Kobeissi et al. (Fri,) studied this question.