Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.
J Neurol. 2013 Dec;260(12):3049-54. doi: 10.1007/s00415-013-7119-4. Epub 2013 Sep 26.
The question of whether i.v. rt-PA is beneficial in patients with ischaemic stroke and atrial fibrillation (AF) remains unresolved. Our objective was to evaluate the outcome of patients with AF who received i.v. rt-PA for stroke in the registries of Lille (France) and Belgrade (Serbia). End-points were poor outcome [modified Rankin Scale (mRS) 3-6], and symptomatic haemorrhagic transformation (sHT) according to ECASS3. Of 734 consecutive patients, 155 (21.2 %) had AF. The unadjusted comparison found patients with AF to be 12 years older, more likely to be women, to have hypertension, and baseline INR > 1.2, and less likely to be smokers. They had higher baseline NIHSS scores, diastolic blood pressure, and serum glucose concentrations, and lower platelet counts. They did not differ for sHT (5.8 vs. 5.5 %; p = 0.893), but they more frequently had poor outcomes (52.3 vs. 35.2 %; p < 0.001) and death (21.9 vs. 9.0 %; p < 0.001). The only independent predictor of sHT was baseline NIHSS (adjOR 1.05 per 1 point increase; 95 % CI 1.01-1.10). Independent variables associated with poor outcome were age (adjOR 1.04 for 1 year increase; 95 % CI 1.03-1.06), baseline NIHSS (adjOR 1.17 per 1 point increase; 95 % CI 1.13-1.21), and sHT (adjOR 47.6; 95 % CI 10.2-250) but not AF. In patients treated with i.v. rt-PA for cerebral ischaemia, those with AF have worse outcomes because they are older and have more severe strokes at admission. This result suggests that we should focus on prevention and research of more aggressive strategies at the acute stage.
静脉注射重组组织型纤溶酶原激活剂（rt-PA）是否对伴有心房颤动（AF）的缺血性脑卒中患者有益，这一问题仍未得到解决。本研究旨在评估里尔（法国）和贝尔格莱德（塞尔维亚）注册中心接受静脉 rt-PA 治疗的 AF 患者的预后。终点为预后不良（改良 Rankin 量表（mRS）3-6）和症状性出血性转化（sHT），依据 ECASS3 进行评估。在 734 例连续患者中，155 例（21.2%）患有 AF。未经调整的比较发现，AF 患者年龄大 12 岁，更可能为女性，患有高血压，基线 INR>1.2，且更不可能为吸烟者。他们的基线 NIHSS 评分、舒张压和血清葡萄糖浓度较高，血小板计数较低。两组 sHT 发生率无差异（5.8%比 5.5%；p=0.893），但预后不良（52.3%比 35.2%；p<0.001）和死亡（21.9%比 9.0%；p<0.001）更为常见。sHT 的唯一独立预测因子是基线 NIHSS（调整后的优势比 1.05，每增加 1 分；95%CI 1.01-1.10）。与预后不良相关的独立变量为年龄（调整后的优势比每年增加 1.04；95%CI 1.03-1.06）、基线 NIHSS（调整后的优势比每增加 1 分增加 1.17；95%CI 1.13-1.21）和 sHT（调整后的优势比 47.6；95%CI 10.2-250），但与 AF 无关。在接受静脉 rt-PA 治疗脑缺血的患者中，AF 患者的预后较差，因为他们年龄更大，且入院时卒中更严重。这一结果表明，我们应将重点放在预防和研究急性期更积极的策略上。
