Smaal J A, de Ridder I R, Heshmatollah A, van Zwam W H, Dippel Dwj, Majoie C B, Brown S, Goyal M, Campbell Bcv, Muir K W, Demchuck A M, Davalos A, Jovin T G, Mitchell P J, White P, Saver J L, Hill M D, Roos Y B, van der Lugt A, van Oostenbrugge R J
Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Eur Stroke J. 2020 Sep;5(3):245-251. doi: 10.1177/2396987320923447. Epub 2020 May 13.
Atrial fibrillation is an important risk factor for ischemic stroke, and is associated with an increased risk of poor outcome after ischemic stroke. Endovascular thrombectomy is safe and effective in acute ischemic stroke patients with large vessel occlusion of the anterior circulation. This meta-analysis aims to investigate whether there is an interaction between atrial fibrillation and treatment effect of endovascular thrombectomy, and secondarily whether atrial fibrillation is associated with worse outcome in patients with ischemic stroke due to large vessel occlusion.
Individual patient data were from six of the recent randomised clinical trials (MR CLEAN, EXTEND-IA, REVASCAT, SWIFT PRIME, ESCAPE, PISTE) in which endovascular thrombectomy plus standard care was compared to standard care alone. Primary outcome measure was the shift on the modified Rankin scale (mRS) at 90 days. Secondary outcomes were functional independence (mRS 0-2) at 90 days, National Institutes of Health Stroke Scale score at 24 h, symptomatic intracranial hemorrhage and mortality at 90 days. The primary effect parameter was the adjusted common odds ratio, estimated with ordinal logistic regression (shift analysis); treatment effect modification of atrial fibrillation was assessed with a multiplicative interaction term.
Among 1351 patients, 447 patients had atrial fibrillation, 224 of whom were treated with endovascular thrombectomy. We found no interaction of atrial fibrillation with treatment effect of endovascular thrombectomy for both primary (-value for interaction: 0.58) and secondary outcomes. Regardless of treatment allocation, we found no difference in primary outcome (mRS at 90 days: aOR 1.11 (95% CI 0.89-1.38) and secondary outcomes between patients with and without atrial fibrillation.
We found no interaction of atrial fibrillation on treatment effect of endovascular thrombectomy, and no difference in outcome between large vessel occlusion stroke patients with and without atrial fibrillation.
心房颤动是缺血性卒中的重要危险因素，且与缺血性卒中后不良预后风险增加相关。血管内血栓切除术对前循环大血管闭塞的急性缺血性卒中患者安全有效。本荟萃分析旨在研究心房颤动与血管内血栓切除术治疗效果之间是否存在相互作用，其次研究心房颤动是否与大血管闭塞所致缺血性卒中患者的预后较差相关。
个体患者数据来自最近的六项随机临床试验（MR CLEAN、EXTEND-IA、REVASCAT、SWIFT PRIME、ESCAPE、PISTE），这些试验将血管内血栓切除术加标准治疗与单纯标准治疗进行了比较。主要结局指标是90天时改良Rankin量表（mRS）的变化。次要结局包括90天时的功能独立性（mRS 0-2）、24小时时的美国国立卫生研究院卒中量表评分、有症状的颅内出血和90天时的死亡率。主要效应参数是经调整的共同比值比，采用有序逻辑回归（变化分析）估计；心房颤动的治疗效果修正通过乘法交互项进行评估。
在1351例患者中，447例患者有心房颤动，其中224例接受了血管内血栓切除术。我们发现，对于主要结局（交互作用P值：0.58）和次要结局，心房颤动与血管内血栓切除术的治疗效果均无相互作用。无论治疗分配如何，我们发现有心房颤动和无心房颤动的患者在主要结局（90天时的mRS：调整后的比值比1.11（95%可信区间0.89-1.38））和次要结局方面均无差异。
我们发现心房颤动对血管内血栓切除术的治疗效果无相互作用，大血管闭塞性卒中患者中有心房颤动和无心房颤动的患者在结局方面无差异。
