Sung Sheng-Feng, Chen Yu-Wei, Tseng Mei-Chiun, Ong Cheung-Ter, Lin Huey-Juan
Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.
Clin Neurol Neurosurg. 2013 Jul;115(7):892-5. doi: 10.1016/j.clineuro.2012.08.034. Epub 2012 Sep 16.
Atrial fibrillation (AF) is associated with poor outcome after intravenous thrombolysis probably due to greater pretreatment stroke severity. We conducted this retrospective study to determine whether AF is an independent predictor for clinical outcome in patients stratified by initial stroke severity.
A total of 143 acute ischemic stroke patients who received intravenous thrombolysis within 3h after onset were enrolled. The patients were categorized according to the baseline stroke severity by National Institute of Health Stroke Scale (NIHSS) score (≤10 vs. >10) and the presence of AF or not. Favorable 90-day outcome was defined as a modified Rankin Scale (mRS) score<2.
Among the 100 patients with severe stroke (NIHSS>10), those with AF (n=52) had a higher proportion of favorable 90-day outcome than those without AF (31% vs. 8%, P=0.005). After adjustment for age, baseline glucose level, and onset to treatment time, the difference remained significant (odds ratio 5.80, 95% confidence interval 1.63-20.68). In patients with mild stroke (NIHSS≤10), no difference in clinical outcome was found between AF (n=20) and non-AF (n=23) groups.
Presence of AF was associated with favorable 90-day outcome following intravenous thrombolysis in patients with severe stroke at baseline, while the association did not exist in patients with mild stroke.
心房颤动（AF）与静脉溶栓治疗后预后不良相关，可能是由于溶栓前卒中严重程度更高。我们进行了这项回顾性研究，以确定在根据初始卒中严重程度分层的患者中，AF是否是临床预后的独立预测因素。
共纳入143例急性缺血性卒中患者，这些患者在发病后3小时内接受了静脉溶栓治疗。根据美国国立卫生研究院卒中量表（NIHSS）评分（≤10分与>10分）以及是否存在AF对患者进行分类。90天良好预后定义为改良Rankin量表（mRS）评分<2分。
在100例重度卒中患者（NIHSS>10）中，合并AF的患者（n=52）90天良好预后的比例高于未合并AF的患者（31%对8%，P=0.005）。在调整年龄、基线血糖水平和发病至治疗时间后，差异仍然显著（比值比5.80，95%置信区间1.63-20.68）。在轻度卒中患者（NIHSS≤10）中，AF组（n=20）和非AF组（n=23）的临床预后无差异。
基线时为重度卒中的患者，AF的存在与静脉溶栓治疗后90天良好预后相关，而轻度卒中患者不存在这种相关性。
