Key result
AF linked to ~49% lower odds of favorable 90-day functional outcomes post-IVT, but not post-EVT.
Why the study?
The overall prevalence of AF and its precise influence on clinical outcomes after reperfusion therapy in acute ischaemic stroke remained elusive.
Does the presence of atrial fibrillation worsen clinical outcomes in acute ischaemic stroke patients undergoing reperfusion therapy?
Meta-Analysis (n=66,887)
Does the presence of atrial fibrillation worsen clinical outcomes in acute ischaemic stroke patients undergoing reperfusion therapy?
Effect estimate: OR 0.512 (95% CI 0.376-0.696)
p-value: p=<0.001
Atrial fibrillation is highly prevalent in acute ischemic stroke patients undergoing reperfusion therapy and is associated with worse 90-day functional outcomes following intravenous thrombolysis, but not endovascular thrombectomy.
AF signals poorer 90-day outcomes after IVT but not EVT; extends meta-analytic evidence for modality-specific prognostication in reperfusion.
Atrial fibrillation (AF) significantly contributes to acute ischaemic stroke (AIS), yet its precise influence on clinical outcomes post-intravenous thrombolysis (IVT) and post-endovascular thrombectomy (EVT) has remained elusive. Furthermore, the overall prevalence of AF in AIS patients undergoing reperfusion therapy has not been clearly determined. Employing random-effects meta-analyses, this research aimed to estimate the pooled prevalence of AF among AIS patients undergoing reperfusion therapy, while also examining the association between AF and clinical outcomes such as functional outcomes, symptomatic intracerebral haemorrhage (sICH) and mortality. Studies comparing AF and non-AF patient groups undergoing reperfusion therapy were identified and included following an extensive database search. Forty-nine studies (n = 66,887) were included. Among IVT patients, the prevalence of AF was 31% (Effect Size [ES] 0.31 [95%CI 0.28–0.35], p < 0.01), while in EVT patients, it reached 42% (ES 0.42 [95%CI 0.38–0.46], p < 0.01), and in bridging therapy (BT) patients, it stood at 36% (ES 0.36 [95%CI 0.28–0.43], p < 0.01). AF was associated with significantly lower odds of favourable 90-day functional outcomes post IVT (Odds Ratio [OR] 0.512 [95%CI 0.376–0.696], p < 0.001), but not post EVT (OR 0.826 [95%CI 0.651–1.049], p = 0.117). Our comprehensive meta-analysis highlights the varying prevalence of AF among different reperfusion therapies and its differential impact on patient outcomes. The highest pooled prevalence of AF was observed in EVT patients, followed by BT and IVT patients. Interestingly, our analysis revealed that AF was significantly associated with poorer clinical outcomes following IVT. Such an association was not observed following EVT.
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Patel et al. (2023) conducted a meta-analysis in Acute ischaemic stroke (AIS) undergoing reperfusion therapy (n=66,887). Atrial fibrillation (AF) vs. Non-AF was evaluated on Favourable 90-day functional outcomes post intravenous thrombolysis (IVT) (OR 0.512, 95% CI 0.376-0.696, p=<0.001). Atrial fibrillation was associated with significantly lower odds of favourable 90-day functional outcomes post-intravenous thrombolysis (OR 0.512; 95% CI 0.376–0.696; p<0.001), but not post-EVT.
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