Key result
AF linked to worse post-stroke outcomes only in patients with high CHA2DS2-VASc scores.
Why the study?
The prognosis of acute ischemic stroke patients treated with IV rtPA is poorer in AF patients, potentially due to greater stroke severity and higher pre-stroke CHA2DS2-VASc scores, but the role of CHA2DS2-VASc in outcome stratification was unclear.
Does the presence of atrial fibrillation worsen outcomes in acute ischemic stroke patients treated with IV-rtPA when stratified by pre-stroke CHA2DS2-VASc score?
Cohort
Does the presence of atrial fibrillation worsen outcomes in acute ischemic stroke patients treated with IV-rtPA when stratified by pre-stroke CHA2DS2-VASc score?
Pre-stroke CHA2DS2-VASc scores can effectively stratify outcomes in acute ischemic stroke patients receiving IV thrombolysis, demonstrating that AF only worsens outcomes in patients with scores ≥ 3.
May inform AF prognosis discussions by pre-stroke CHA2DS2-VASc in acute stroke; extends observational data but leaves open prospective validation.
The prognosis of acute ischemic stroke patients treated with intravenous (IV) recombinant tissue plasminogen activator (rtPA) is poorer in patients with atrial fibrillation (AF) than patients without AF, which might be related to the greater stroke severity in AF patients. Higher pre-stroke CHA2DS2-VASc scores are associated with greater stroke severity and poorer outcomes. AF Patients tend to have higher CHA2DS2-VASc scores than the non-AF patients. We thus hypothesized that pre-stroke CHA2DS2-VASc scores can be used to improve outcome stratification of IV thrombolysis therapy in acute stroke patients with and without AF. We retrospectively enrolled ischemic stroke patients who received IV-rtPA and categorized them into 2 groups: low-risk (CHA2DS2-VASc scores ≤ 2) and high-risk (CHA2DS2-VASc scores ≥ 3) groups. We compared the outcomes between AF and non-AF patients and the interactive effects of the levels of CHA2DS2-VASc scores on this outcome difference. In the low-risk group, there was no difference in outcomes between the AF and non-AF patients. In the high-risk group, the AF patients had worse outcomes at 3 and 6 months. Our results suggest that pre-stroke CHA2DS2-VASc scores are a useful outcome predictor of IV thrombolytic therapy in acute stroke patients with AF.
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Wu et al. (2020) conducted a cohort in Acute ischemic stroke. Atrial fibrillation vs. No atrial fibrillation was evaluated on Outcomes at 3 and 6 months. Atrial fibrillation was associated with worse outcomes at 3 and 6 months in acute stroke patients with high pre-stroke CHA2DS2-VASc scores (≥3), but not in those with low scores (≤2).
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