Reperfusion therapies in patients with acute ischaemic stroke and atrial fibrillation: data on safety and effectiveness from a multi-centre cohort study.
Virginia Cancelloni, Mariachiara Buratti, Georgios Tsivgoulis, Karen L Furie, Prasanna Tadi, Valeria Caso, Cecilia Becattini, Giancarlo Agnelli, Marialuisa Zedde, Azmil H Abdul-Rahim, Andrea Alberti, Michele Venti, Ilaria Leone de Magistris, Monica Acciarresi, Cataldo D'Amore, Maria G Mosconi, Ludovica A Cimini, Manuel Cappellari, Jukka Putaala, Liisa Tomppo, Turgut Tatlisumak, Fabio Bandini, Simona Marcheselli, Alessandro Pezzini, Sung-I I Sohn, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, George Ntaios, Efstathia Karagkiozi, George Athanasakis, Kostantinos Makaritsis, Dimitrios Sagris, Anastasia Adamou, Kostantinos Vadikolias, Lina Palaiodimou, Maria Chondrogianni, Nicola Mumoli, Franco Galati, Simona Sacco, Cindy Tiseo, Francesco Corea, Walter Ageno, Marta Bellesini, Giorgio Silvestrelli, Alfonso Ciccone, Michelangelo Mancuso, Giovanni Orlandi, Rosario Pascarella, Tiziana Tassinari, Christina Rueckert, Antonio Baldi, Danilo Toni, Federica Lettieri, Martina Giuntini, Enrico M Lotti, Yuriy Flomin, Alessio Pieroni, Odysseas Kargiotis, Theodore Karapanayiotides, Panagiotis Halvatsiotis, Serena Monaco, Mario M Baronello, Laszlò Csiba, Lilla Szabò, Alberto Chiti, Elisa Giorli, Massimo Del Sette, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Patrik Michel, Peter Vanacker, Kristian Barlinn, Lars P Pallesen, Jessica Kepplinger, Dirk Deleu, Vanessa Gourbali, Shadi Yaghi, Maurizio Paciaroni
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引用次数: 0
Abstract
Background: Intravenous thrombolysis (IVT) and/or endovascular therapy (EVT) are currently considered best practices in acute stroke patients. Data regarding the efficacy and safety of reperfusion therapies in patients with atrial fibrillation (AF) are conflicting as regards haemorrhagic transformation, mortality, and functional outcome. This study sought to investigate for any differences, in terms of safety and effectiveness, between AF patients with acute ischaemic stroke (AIS) treated and untreated with reperfusion therapies.
Methods: Data from two multicenter cohort studies (RAF and RAF-NOACs) on consecutive patients with AF and AIS were analyzed to compare patients treated and not treated with reperfusion therapies (IVT and/or EVT). Multivariable logistic regression analysis was performed to identify independent predictors for outcome events: 90-day good functional outcome and mortality. A propensity score matching (PSM) analysis compared treated and untreated patients.
Results: Overall, 441 (25.4%) were included in the reperfusion-treated group and 1,295 (74.6%) in the untreated group. The multivariable model suggested that reperfusion therapies were significantly associated with good functional outcome. Rates of mortality and disability were higher in patients not treated, especially in the case of higher NIHSS scores. In the PSM comparison, 173/250 patients (69.2%) who had received reperfusion therapies had good functional outcome at 90 days, compared to 146/250 (58.4%) untreated patients (p = 0.009, OR: 1.60, 95% CI:1.11-2.31).
Conclusions: Patients with AF and AIS treated with reperfusion therapies had a significantly higher rate of good functional outcome and lower rates of mortality compared to those patients with AF and AIS who had undergone conservative treatment.
期刊介绍:
Neurological Sciences is intended to provide a medium for the communication of results and ideas in the field of neuroscience. The journal welcomes contributions in both the basic and clinical aspects of the neurosciences. The official language of the journal is English. Reports are published in the form of original articles, short communications, editorials, reviews and letters to the editor. Original articles present the results of experimental or clinical studies in the neurosciences, while short communications are succinct reports permitting the rapid publication of novel results. Original contributions may be submitted for the special sections History of Neurology, Health Care and Neurological Digressions - a forum for cultural topics related to the neurosciences. The journal also publishes correspondence book reviews, meeting reports and announcements.