PhD Scientific Days 2023

Clinical Medicine I.

Atrial fibrillation is associated with increased long-term mortality in patients undergoing mechanical thrombectomy for acute ischaemic stroke by cerebral large vessel occlusion

Text of the abstract

Aims:
Acute cerebral large vessel occlusion without timely reperfusion therapy is associated with
poor functional outcome and high mortality. Atrial fibrillation (AF) is a major risk factor of
cerebral large vessel occlusion (LVO), and it was shown to be an independent predictor of
adverse neurological outcome and 1 year mortality following mechanical thrombectomy
(MT). We aimed to clarify the potential effect of AF on the long term, 5-year mortality
following endovascular stroke therapy.
Methods:
Consecutive patients treated with MT for cerebral large vessel occlusion (LVO) between the
1st of January 2015 and the 31st of December 2017 were included in our prospective registry.
All patients were treated in a single high-volume center. Baseline clinical characteristics and
long-term mortality data were compared between the patients with newly diagnosed or known
AF on admission, and patients without known AF. Mortality follow up data was acquired
from National Health Insurance database. The mortality follow-up rate was over 98%.
Results:
The clinical and follow up data of 445 MT patients were analyzed, 136 patients (30,5%) had
AF. Amongst the treated patients 43 patients (31,6%) had newly diagnosed, and 93 patients
(68,4 %) had known AF during the acute admission. Patients with AF were characterized by
higher median age (71 vs. 62 p=0.0001), higher prevalence of hypertension (53.24 vs 42.71
p=0.0489), female predominance (55.68 vs. 45.32 p=0.0228) and similarly severe
neurological status on admission (NIHSS 16 vs. 15 p=0.1428) compared to patients without
known arrythmia. Thrombectomy patients with AF were shown to have an increased overall
5-year mortality (HR=1.638 p=0.002) compared to patients in sinus rhythm.
Conclusion:
AF is associated with increased long-term overall mortality in patients undergoing MT for
acute ischemic stroke caused by LVO. Our results underline the significance of effective
screening and treatment strategies of AF in LVO stroke patients to improve prognosis.
Funding: None to declare.