Department of Neurology, Erasmus University Medical Center (EMC), Rotterdam, the Netherlands.
EuroIntervention. 2017 Oct 20;13(8):996-1002. doi: 10.4244/EIJ-D-16-00905.
Endovascular thrombectomy (EVT) improves outcome after acute ischaemic stroke (AIS) caused by an intracranial occlusion. The aim of the present study was to determine whether atrial fibrillation (AF) modifies the effect of EVT.
MR CLEAN was a randomised clinical trial of EVT plus usual care vs. usual care alone for patients with an intracranial occlusion. The primary outcome was the modified Rankin scale (mRS) score at 90 days. The primary effect parameter was the adjusted common odds ratio (acOR), estimated with ordinal logistic regression and adjusted for age and stroke severity at baseline. Treatment effect modification by AF was assessed using a multiplicative interaction variable. We included all 500 patients. In total, 135 (27%) had AF. These patients were older, had a worse pre-stroke mRS score and were less often treated with IV alteplase. In patients without AF, the estimated treatment effect was similar to the overall treatment effect (acOR 1.9, 95% CI: 1.3 to 2.7). In patients with AF, the treatment effect appeared lower (acOR 1.0, 95% CI: 0.6 to 1.9). The interaction of treatment effect and AF was not significant (p=0.09, after adjustment p=0.12).
This study did not show significant difference in the EVT effect between acute stroke patients with and those without AF.
血管内血栓切除术（EVT）可改善颅内闭塞引起的急性缺血性脑卒中（AIS）患者的预后。本研究旨在确定心房颤动（AF）是否会改变 EVT 的效果。
MR CLEAN 是一项针对颅内闭塞患者进行 EVT 加常规治疗与单纯常规治疗的随机临床试验。主要结局是 90 天时改良 Rankin 量表（mRS）评分。主要效应参数是使用有序逻辑回归估计的调整后的常见优势比（acOR），并根据基线时的年龄和卒中严重程度进行调整。使用乘法交互变量评估 AF 的治疗效果修饰。我们纳入了所有 500 名患者。其中 135 例（27%）患有 AF。这些患者年龄更大，发病前 mRS 评分更差，更常接受 IV 阿替普酶治疗。在无 AF 的患者中，估计的治疗效果与总体治疗效果相似（acOR 1.9，95%CI：1.3 至 2.7）。在 AF 患者中，治疗效果似乎较低（acOR 1.0，95%CI：0.6 至 1.9）。治疗效果与 AF 的交互作用不显著（p=0.09，调整后 p=0.12）。
本研究未显示急性脑卒中患者中 EVT 效果在有 AF 和无 AF 之间存在显著差异。
