Kimura Kazumi, Iguchi Yasuyuki, Shibazaki Kensaku, Iwanaga Takeshi, Yamashita Shinji, Aoki Junya
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Okayama, Japan.
J Neurol Sci. 2009 Jan 15;276(1-2):6-8. doi: 10.1016/j.jns.2008.10.018. Epub 2008 Nov 17.
Atrial fibrillation (AF) is a predictor for severe stroke. Intravenous administration of tissue plasminogen activator (t-PA) can improve clinical outcomes in patients with acute ischemic stroke. We investigated clinical characteristics and patient outcome in patients with and without AF after t-PA therapy.
Consecutive ischemic stroke patients treated with t-PA within 3 h of stroke onset were studied prospectively. MRI examinations, including diffusion weighted imaging and MRA, were performed before t-PA thrombolysis. NIHSS scores were obtained before and 7 days after t-PA infusion. The patients were divided into two groups (AF group and Non-AF group). Their clinical characteristics and outcome 7 days and 3 months after t-PA therapy were compared.
85 patients (56 males, mean age, 73.4+/-11.5 years) were enrolled in the present study. The AF-group had 44 patients, and the Non-AF group had 41 patients. Fewer patients with AF had dramatic improvement at 7 days and favorable outcome (mRS 0-1) at 3 months after t-PA therapy than patients without AF (31.8% vs. 61.0%, P=0.007, and 15.9% vs. 46.3%, P=0.002). On the other hand, worsening at 7 days and poor outcome (mRS >3 and death) at 3 months after t-PA therapy were more frequently observed in AF group than Non-AF group (22.7% vs. 9.8%, P=0.107, and 70.5% vs. 41.5%, P=0.007). After adjusting age and gender, patients with AF more frequently had worsening and poor outcome than those without AF (adjusted OR; 4.54, 95% CI 1.04-19.75, P=0.044, and adjusted OR; 2.8, 95% CI 1.10-7.28, P=0.032).
The present study found that acute ischemic stroke patients with AF more frequently had poor outcome after IV-t-PA therapy compared with those without AF.
心房颤动（AF）是严重卒中的一个预测因素。静脉注射组织型纤溶酶原激活剂（t-PA）可改善急性缺血性卒中患者的临床结局。我们研究了t-PA治疗后伴有和不伴有AF的患者的临床特征及患者结局。
对卒中发作3小时内接受t-PA治疗的连续性缺血性卒中患者进行前瞻性研究。在t-PA溶栓前进行MRI检查，包括弥散加权成像和MRA。在t-PA输注前及输注后7天获取美国国立卫生研究院卒中量表（NIHSS）评分。将患者分为两组（AF组和非AF组）。比较两组患者t-PA治疗后7天及3个月时的临床特征及结局。
本研究共纳入85例患者（56例男性，平均年龄73.4±11.5岁）。AF组有44例患者，非AF组有41例患者。与无AF的患者相比，t-PA治疗后7天有显著改善及3个月时有良好结局（改良Rankin量表评分0-1分）的AF患者较少（分别为31.8%对61.0%，P=0.007；15.9%对46.3%，P=0.002）。另一方面，t-PA治疗后7天病情恶化及3个月时有不良结局（改良Rankin量表评分>3分及死亡）在AF组比非AF组更常见（分别为22.7%对9.8%，P=0.107；70.5%对41.5%，P=0.007）。在对年龄和性别进行校正后，伴有AF的患者比不伴有AF的患者更频繁地出现病情恶化及不良结局（校正比值比；4.54，95%置信区间1.04-19.75，P=0.044；校正比值比；2.8，95%置信区间1.10-7.28，P=0.032）。
本研究发现，与无AF的急性缺血性卒中患者相比，伴有AF的患者接受静脉t-PA治疗后更频繁地出现不良结局。
