Outcomes Following Thrombolysis Among Patients With Concomitant Hyperglycaemia And Atrial Fibrillation

Background and Objective:Thrombolysis with recombinant tissue plasminogen activator(rt-PA) has gained international recogntion,factors affecting clinical outcomes have not been well understood yet.The benefits of thrombolysis in patients who have had hyperglycaemia and concomitant atrial fibrillation(AF) have not been formally demonstrated. Hence, we aimed to investigate the outcomes following thrombolysis among patients with concomitant hyperglycaemia and AF in our centre.Methods:1.Prospectively collected data from 120 consecutive patients with acute ischaemic stroke undergoing thrombolysis therapy in single-stroke centres were analysed.2.Analysis of factors influencing patient outcome following thrombolytic,presenting characters : therapyhaemorrhage thansformation(HT),symptomatic intracranial haemorrhage(s ICH), mortality, and favourable outcomes(modified Rankin scale ≤2) at 3 months were compared.3.Patients were divided into concomitant diabetes and AF group(n=47) or non-diabetes and AF group(n=73), to investigate the outcomes following thrombolysis among patients with concomitant diabetes and AF.4.90 patients had no HT were divided into concomitant hyperglycaemia and AF group(n=20) or control group(n=100),to investigate the outcomes following thrombolysis among patients with concomitant hyperglycaemia and AF.Results:1.120 patients were divided into HT(n=26) or non-HT(n=94) group,analysis of factors influencing patient outcome following thrombolytic therapy univariate analysis showed that,AF and hyperglycemia(BG>11.0mmol/L) have impact on neurological outcome in thrombolytic patients with acute ischemic stroke(p<0.05),when other risk factors has no independent impact on neurological outcome in thrombolytic patients.(p>0.05).2.Compare with subgroup of lower blood sugar level,the subgroup of hyperglycaemia less benifite from thrombolysis, hyperglyeaemia have obvious correlation with hemorrhagic transformation,hyperglycaemia have obvious correlation with mortality after thrombolysis. Than patients without AF,patients with AF obvious correlation with hemorrhagic transformation.3.Than patients were divided into concomitant hyperglycaemia and AF group(n=20) or control group(n=100),concomitan thyperglycaemia and AF group has higher rate of history of hypertension(90.0% vs 54.0%,p=0.003), higher rate of history of ischaemic stroke(45.0% vs 13.0%,p=0.01), their three-month death rate was higher(55.0%.vs. 15.0%;p=0.001). Their rate of favourable outco mes at three months was lower(30.0%. vs. 4.0%; p =0.014)4.Both hyperglyeaemiaare and AF are risk factors for hemorrhagic transformation.RR of hemorrhagic transformation associated with the interactions between hyperglyeaemiaare and AF was 6.601(4.939-13.204)in multiplicative model.Conclusions:1.Our study shows that hyperglyeaemia have obvious correlation with hemorrhagic transformation and s ICH,hyperglycaemia have obvious correlation with mortality after thrombolysis.2.AF also has correlation with hemorrhagic transformation and s ICH after thrombolysis.3.Diabetic patients with concomitant atrial fibrillation receive limited benefit from thrombolysis, with a high rate of s ICH and death.