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The related main theme: A. Stroke and Cerebral vascular disorders

Atrial Fibrillation may not be a lethal factor anymore in Acute Ischemic Stroke: A Propensity Score-Matched Analysis

Authers:

Hong-Jie  Jhou, MD 1 , Po-Huang  Chen, MD 2 , Shu-Hao   Chang,  3 , Cho-Hao   Lee, MD 4 , 
1 Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan, ROC
2 Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
3 Department of Computer Science and Information Science, National Formosa University, Yunlin, Taiwan, ROC
4 Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
Corresponding Author:

Cho-Hao   Lee

keywords: Characteristics, Mortality, Acute ischemic stroke, Atrial fibrillation, Intensvie care unit, Propensity-score matching
Abstract for original article

OBJECTIVES /BACKGROUND:
The aim of study is to investigate the clinical characteristics and outcomes of acute ischemic stroke patients with atrial fibrillation (AF) in intensive care unit (ICU).

MATERIAL and METHOD:
A consecutive 1,381 acute ischemic stroke patients were identified in the Medical Information Mart for Intensive Care Database IV in 2008 to 2019. Of 1,381 stroke patients, 543 had AF and 838 had no AF. The differences of clinical characteristics and outcomes in stroke patients with and without AF are compared using propensity score matching.

RESULT:
Mean age of the stroke patients measured 75.7±10.3 years in AF group was older than 64.5±14.6 years in non-AF group (p < .001). Stroke patients with AF were more likely to have higher Charlson comorbidity index (7.7±2.3 v.s. 6.4±2.7, p < .001) than stroke patients without AF. The results showed pneumonia (9.9% v.s. 6.9%, p = .044), respiratory failure (16.9% v.s. 12.3%, p = .015), and the 28-day mortality (18.0% v.s. 10.1%, p < .001) were more frequently observed in stroke patients with AF than stroke patients without AF. After propensity score matching, there were 444 matched pairs. The 28-day mortality was 16.4% in the AF group and 14.0% in the non-AF group (p = .263). The AF group had prolonged the length of ICU stay than the non-AF group (5.3±7.3 v.s. 3.8±5.3, p = .001). In the multivariate analysis, AF did not significantly increase 28-day mortality (adjusted odds ratio, 1.08; 95% confidence interval, 0.99-1.184; p = .073) but respiratory failure (adjusted odds ratio, 5.17; 95% confidence interval, 3.25-8.23; p < .011) seemed to be associated with higher 28-day mortality.

DISCUSSION:
Patients with AF have different clinical characteristics compared with patients without AF. AF was no significant difference regarding increase mortality; however, respiratory failure carries a high risk of mortality in acute ischemic stroke patients with AF.


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