| Objective Intravenous thrombolysis of alteplase(Rt-PA)within 4.5h of onset can benefit patients with ischemic stroke,which may include acute ischemic stroke patients with atrial fibrillation(AF-stroke),namely,atrial fibrillation is not a contraindication to intravenous thrombolysis.However,it is not certain what effect atrial fibrillation itself will have on intravenous thrombolytic therapy in patients,as well as what factors will affect the prognosis of AF-stroke patients after intravenous thrombolytic.The purpose of this study was to observe the efficacy of intravenous thrombolysis in AF-stroke patients,and to investigate the prognostic factors.Methods Ischemic stroke patients with intravenous thrombolysis admitted to three hospitals in Guang Xi province between June 2017 and September 2019 were collected.Firstly,the patients were divided into the ischemic stroke group with atrial fibrillation(AF-stroke)and the ischemic stroke group without atrial fibrillation(No AF-stroke)according to whether they had atrial fibrillation or not.The influence of confounding factors between the two groups was balanced by propensity score matching(PSM),and the clinical data between these two groups were compared based on the data before and after matching.Secondly,according to whether the m RS score ≤ 2 points at 90 days after the onset,the AF-stroke group was divided into two subgroups with good prognosis and poor prognosis.Univariate analysis and multivariate Logistic regression analysis were performed to identify the influencing factors for the prognosis of intravenous thrombolysis in AF-stroke patients.Then,a prediction scoring method based on these factors was developed by using receiver operating characteristic curves(ROC)analysis.Results Before PSM,the number of underlying diseases,the baseline NIHSS score,m RS score after 90 days,mortality,as well as the incidence of intracranial hemorrhage transformation(HT)and symptomatic intracranial hemorrhage(s ICH)was higher in the AF-stroke group.However,after the effects of age,gender,baseline NIHSS score and underlying diseases were balanced between the two groups by 1: 2 PSM,the incidence of HT in the AF-stroke group was higher than that in the control group(26.08% vs.13.19%,P=0.023),but there was no statistically significant difference in other clinical data.Further multivariate Logistic regression analysis between two subgroups showed that baseline NIHSS score(OR=1.163,95%CI: 1.024-1.321,P =0.020 and C-reactive protein(CRP)level(OR=1.034,95%CI: 1.003-1.066,P =0.031)were risk factors for poor prognosis in AF-stroke patients,while non-valvular paroxysmal Paroxysmal atrial fibrillation(NVPAF,OR=0.232,95%CI:0.064-0.839,P =0.026)was protective factors.In addition,the score of baseline NIHSS score and CRP level were assigned 0～3 points according to the four-point interval,and 0～1 point according to whether the type of af was paroxysmal af or not.ROC analysis showed that the area under the curve of the sum of the scores of each factor was 0.847(CI: 0.740-0.918),which was significantly higher than the area under the curve of each of these factors.Moreover,the sensitivity(95.35%)and specificity(63.33%)to predict a poor prognosis of thrombolytic therapy in AF-stroke patients were highest when the total score of each factor was 4 points.Conclusion Although atrial fibrillation may lead to a slightly increased incidence of HT in patients with ischemic stroke after intravenous thrombolysis with Rt-PA,it does not affect the clinical outcome at 90 days after onset.Therefore,AF-stroke patients still benefit from intravenous thrombolysis of Rt-PA.In addition,among AF-stroke patients,patients with low NIHSS score,low CRP level,and with NVPAF had a higher chance of achieving a good prognosis.In the future,comprehensive consideration of the influence of various factors and the establishment of a joint evaluation method may provide a more comprehensive basis for the prediction of thrombolytic prognosis of AF-stroke patients. |
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