Prognostic analysis of atrial fibrillation patients with acute cerebral infarction: a retrospective study of 330 cases over a 10-year period

Abstract

Background: The neurologic outcome of atrial fibrillation (AF) patients with acute ischemic stroke (AIS) is usually worse than those without AF. The aim of our study was to evaluate prognostic factors in AF-AIS. Methods We retrospectively collected information about AF-AIS patients admitted to our department from Jan. 2013 and Aug. 2023. According to the modified Rankin Scale (mRS) score at discharge, patients were divided into two groups: group A with favorable outcomes (mRS ≤ 2,) and group B with poor outcomes (mRS > 2). Results A total of 330 AF-AIS patients met the inclusion criteria, including 95 in group A and 235 in group B. The large-, medium- and small-infarct sizes were 45.5%, 31.5% and 23.0%, respectively. Intravenous alteplase thrombolysis (IV-rtPA) was prescribed to 69 patients. Parenchymal hemorrhage (PH) was present in 53 (16.1%) patients. The incidence of PH for patients with IV-rtPA was 34.8% (24/69), and 17.9% (45/251) for no-IV-rtPA patients. In univariate analysis, older age, higher NIHSS score and glucose, lower level of triglyceride, lager infarct size and PH were all associated with a poor outcome. No difference was found between the good and poor outcomes with IV-rtPA (18.9% vs. 21.7%, p = 0.578). In multivariate analysis, age (OR 1.059, 95% CI 1.024–1.094, p = 0.001), NIHSS score (OR 1.305, 95% CI 1.210–1.407, p < 0.001), infarct size (OR 2.485, 95% CI 1.018–6.062, p = 0.045), glucose (OR 1.994, 95% CI 1.011–3.933, p = 0.046) and PH (OR 4.130, 95% CI 1.303–13.092, p = 0.016) were independently associated with poor outcome. And, large infarct size (OR 3.786, 95% CI 1.912–7.459, p < 0.001), IV-rtPA (OR 4.904, 95% CI 2.452–9.808, p < 0.001), lower baseline level of triglyceride (OR 3.797, 95% CI 1.636–8.817, p = 0.002) and diabetes mellitus (OR 2.973, 95% CI 1.477–5.983, p = 0.002) were significantly associated with the development of PH. Conclusion The majority of AF-AIS patients had a poor outcome, which was independently associated with age, NIHSS score, infarct size, glucose and PH. IV-rtPA was related to an increased risk of PH and failed to improve overall short-term outcomes, especially for those with a large infarct size, a lower level of baseline triglyceride and a history of diabetes mellitus.