Reperfusion therapies in patients with acute ischaemic stroke and atrial fibrillation: data on safety and effectiveness from a multi-centre cohort study.

Autor: Cancelloni V; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy. virginia.cancelloni@gmail.com., Buratti M; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Tsivgoulis G; Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon' University Hospital, Athens, Greece., Furie KL; Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA., Tadi P; Geisinger Medical Center, Danville, PA, USA., Caso V; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Becattini C; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Agnelli G; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Zedde M; Neurology Unit, Stroke Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy., Abdul-Rahim AH; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.; Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.; Stroke Division, Mersey and West Lancashire Teaching Hospitals NHS Trust, St Helens, UK., Alberti A; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Venti M; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., de Magistris IL; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Acciarresi M; SC Neurologia, San Giovanni Battista Hospital, Foligno, Italy., D'Amore C; Stroke Unit, Ospedale Di Portogruaro, Portogruaro, Venice, Italy., Mosconi MG; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Cimini LA; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Cappellari M; SSO Stroke Unit, UO Neurologia, DAI Di Neuroscienze, AOUI, Verona, Italy., Putaala J; Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland., Tomppo L; Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland., Tatlisumak T; Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.; Deparment of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden., Bandini F; SC Neurologia, Villa Scassi Hospital, ASL 3 Genovese, Genoa, Italy., Marcheselli S; Neurologia d'Urgenza E Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy., Pezzini A; Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy., Sohn SI; Deparment of Neurology, Keimyung University School of Medicine, Daegu, South Korea., Lorenzini G; SC Di Medicina E Chirurgia d'Accettazione E d'Urgenza, Ospedali Di Pontedera E Volterra, Pontedera E Volterra, Italy., Tassi R; Stroke Unit, AOU Senese, Siena, Italy., Guideri F; Stroke Unit, AOU Senese, Siena, Italy., Acampa M; Stroke Unit, AOU Senese, Siena, Italy., Ntaios G; Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece., Karagkiozi E; Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece., Athanasakis G; Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece., Makaritsis K; Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece., Sagris D; Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece., Adamou A; Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece., Vadikolias K; Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece., Palaiodimou L; Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon' University Hospital, Athens, Greece., Chondrogianni M; Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon' University Hospital, Athens, Greece., Mumoli N; UOC General Medicine, ASST Ovest Milanese, Legnano Hospital, Legnano, Italy., Galati F; Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy., Sacco S; Department of Neurology, University of L'Aquila, Avezzano Hospital, Avezzano, Italy., Tiseo C; Department of Neurology, University of L'Aquila, Avezzano Hospital, Avezzano, Italy., Corea F; SC Neurologia, San Giovanni Battista Hospital, Foligno, Italy., Ageno W; Department of Internal Medicine, Insubria University, Varese, Italy., Bellesini M; Department of Internal Medicine, Insubria University, Varese, Italy., Silvestrelli G; SC Di Neurologia E SS Di Stroke Unit, ASST Di Mantova, Mantua, Italy., Ciccone A; SC Di Neurologia E SS Di Stroke Unit, ASST Di Mantova, Mantua, Italy., Mancuso M; Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy., Orlandi G; Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy.; Neurologia, Ospedale Apuano, Massa Carrara, Italy., Pascarella R; Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Reggio Emilia, Italy., Tassinari T; Stroke Unit, Department of Neurology, Santa Corona Hospital, Pietra Ligure, Savona, Italy., Rueckert C; Neuroscience and Cognition, Utrecht University, Utrecht, Netherlands., Baldi A; Stroke Unit, Ospedale Di Portogruaro, Portogruaro, Venice, Italy., Toni D; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy., Lettieri F; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy., Giuntini M; Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy., Lotti EM; UO Neurologia Presidio Ospedaliero Di Ravenna Azienda USL Della Romagna, Ravenna, Italy., Flomin Y; Stroke Unit and Neurorehabilitation Unit MC, Universal Clinic 'Oberig', Kiev, Ukraine., Pieroni A; UOSD Stroke Unit, Azienda Ospedale Università Padova, Padua, Italy., Kargiotis O; Stroke Unit, Metropolitan Hospital, Piraeus, Greece., Karapanayiotides T; 2nd Department of Neurology, AHEPA University Hospital, Thessaloniki, Greece., Halvatsiotis P; Second Department of Internal Medicine-Propaedeutic and Diabetes Center, Medical School, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece., Monaco S; Stroke Unit, Ospedale Civico, Palermo, Italy., Baronello MM; Stroke Unit, Ospedale Civico, Palermo, Italy., Csiba L; Stroke Unit, University of Debrecen, Debrecen, Hungary., Szabò L; Stroke Unit, University of Debrecen, Debrecen, Hungary., Chiti A; Neurologia, Ospedale Apuano, Massa Carrara, Italy., Giorli E; Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy., Del Sette M; UOC Neurologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Imberti D; Department of Internal Medicine, Ospedale Civile Di Piacenza, Piacenza, Italy., Zabzuni D; Municipal Budgetary Healthcare Institution of Novosibirsk, Novosibirsk State Medical University, City Clinical Hospital N°1, Novosibirsk, Russia., Doronin B; Municipal Budgetary Healthcare Institution of Novosibirsk, Novosibirsk State Medical University, City Clinical Hospital N°1, Novosibirsk, Russia., Volodina V; Municipal Budgetary Healthcare Institution of Novosibirsk, Novosibirsk State Medical University, City Clinical Hospital N°1, Novosibirsk, Russia., Michel P; Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland., Vanacker P; Department of Neurology, Born Bunge Institute, Antwerp University Hospital, Antwerp, Belgium., Barlinn K; Department of Neurology, Dresden University Stroke Center, Dresden, Germany., Pallesen LP; Department of Neurology, Dresden University Stroke Center, Dresden, Germany., Kepplinger J; Department of Neurology, Dresden University Stroke Center, Dresden, Germany., Deleu D; Hamad Medical Corporation, Doha, Qatar., Gourbali V; Department of Neurology, Evangelismo Hospital, Athens, Greece., Yaghi S; Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA., Paciaroni M; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.
Jazyk: angličtina
Zdroj: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology [Neurol Sci] 2024 Oct; Vol. 45 (10), pp. 4895-4902. Date of Electronic Publication: 2024 May 22.
DOI: 10.1007/s10072-024-07555-z
Abstrakt: Background: Intravenous thrombolysis (IVT) and/or endovascular therapy (EVT) are currently considered best practices in acute stroke patients. Data regarding the efficacy and safety of reperfusion therapies in patients with atrial fibrillation (AF) are conflicting as regards haemorrhagic transformation, mortality, and functional outcome. This study sought to investigate for any differences, in terms of safety and effectiveness, between AF patients with acute ischaemic stroke (AIS) treated and untreated with reperfusion therapies.
Methods: Data from two multicenter cohort studies (RAF and RAF-NOACs) on consecutive patients with AF and AIS were analyzed to compare patients treated and not treated with reperfusion therapies (IVT and/or EVT). Multivariable logistic regression analysis was performed to identify independent predictors for outcome events: 90-day good functional outcome and mortality. A propensity score matching (PSM) analysis compared treated and untreated patients.
Results: Overall, 441 (25.4%) were included in the reperfusion-treated group and 1,295 (74.6%) in the untreated group. The multivariable model suggested that reperfusion therapies were significantly associated with good functional outcome. Rates of mortality and disability were higher in patients not treated, especially in the case of higher NIHSS scores. In the PSM comparison, 173/250 patients (69.2%) who had received reperfusion therapies had good functional outcome at 90 days, compared to 146/250 (58.4%) untreated patients (p = 0.009, OR: 1.60, 95% CI:1.11-2.31).
Conclusions: Patients with AF and AIS treated with reperfusion therapies had a significantly higher rate of good functional outcome and lower rates of mortality compared to those patients with AF and AIS who had undergone conservative treatment.
(© 2024. The Author(s).)
Databáze: MEDLINE
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