Prognosis Of Patients With Acute Ischemic Stroke Complicated With Atrial Fibrillation Undergoing Mechanical Thrombectomy And The Study Of TCM Syndrome Elements Distribution

Objective1.To observe the prognosis of mechanical thrombectomy in patients with acute ischemic stroke with atrial fibrillation,and to compare the efficacy and safety of mechanical thrombectomy with patients with acute ischemic stroke without atrial fibrillation.2.Analysis of TCM syndrome elements in patients with and without AF.MethodsA retrospective analysis of patients who underwent mechanical thrombectomy in the Department of Guangdong Hospital of Traditional Chinese Medicine from January 1,2012 to December 31,2018.Collect patient data,including:(1)demographic characteristics such as age and gender;(2)risk factors including hypertension,diabetes,atrial fibrillation,coronary heart disease,stroke history,hyperlipidemia,smoking,drinking,etc.3)Preoperative and surgical conditions,including preoperative NIHSS score,onset time,operation time,number of intraoperative thrombectomy,intraoperative revascularization,etc.(4)NIHSS scores and postoperative resistance at 24h and 7 days after surgery,use of clotting anti-poly drugs,postoperative complications,and mRS scores at 90 days after surgery;(5)partial and auxiliary examination results during hospitalization including CT and MRI;(6)the TCM syndrome elements.The 7-day postoperative NIHSS score was compared with the baseline NIHSS score and the 90-day mRS score was the primary outcome.Statistical analysis was performed using Empower Stats.ResultsEventually,92 patients were included in this subject,including 46 in the AF group and 46 in the non-AF group.In the baseline data of the two groups,the mean age of the AF group was higher than that of the non-AF group(73.00±8.14 years-old vs 67.35±10.92 years-old,p=0.022),and the proportion of patients with heart failure was higher(26.09%vs 2.17%,p<0.001),the rest of the general information such as gender,hypertension,diabetes,hyperlipidemia,etc.are not statistically different.During the mechanical thrombectomy,the number of thrombectomy in the AF group was higher(2.41±1.47 vs 1.91±1.28,p=0.037).In the AF group,21 patientshad a good early prognosis,and 22 patients in the non-AF group had a good early prognosis.There was no significant difference in the prognosis between the two groups on the 7th day after surgery(45.65%vs 47.83%,p=0.834).On the 90th day after surgery,2 patients in the non-atrial fibrillation group had shedding.Among the remaining 44 patients,22 patients(47.8%)had a good prognosis.11 patients(23.91%)in the atrial fibrillation group had a good prognosis.The prognosis after 90 days,p=0.010,there was a statistical difference.After adjusting for gender,age,and preoperative NIHSS scores,the risk of adverse prognosis increased in patients with AF after 90 days(OR=2.58,95%CI:0.93-7.16,p=0.0692).Multivariate analysis showed that the preoperative baseline NIHSS score(OR=1.0694,95%CI:1.0011-1.1422,p=0.0462)was an independent risk factor for early prognosis,with a single anti-poly drug after surgery(OR=0.0421,95).%CI:0.0064-0.2767,p=0.0010)or double anti-poly drug(OR=0.1211,95%CI:0.0235-0.6237,p=0.0116)is an independent protective factor for early prognosis;preoperative NIHSS score(OR=1.1764),95%CI:1.0845-1.2760,p<0.0001),number of thrombectomy(OR=1.6763,95%CI:1.1551-2.4325,p=0.0065)is an independent risk factor for long-term prognosis,using double anti-aggregation after surgery The drug(OR=0.2250,95%CI:0.0578-0.8754,p<0.0001)was an independent protective factor for long-term prognosis.TCM syndrome analysis showed that among the patients with acute stroke who had atrial fibrillation,wind syndrome and phlegm syndrome were the main syndromes.Compared with patients with acute stroke without atrial fibrillation,the distribution of blood stasis syndrome was different(17.39%vs 2.17%,p=0.014).There was no statistical difference in the distribution of syndrome types.There was no significant difference in the distribution of TCM syndromes between early outcomes and long-term prognosis.Conclusion(1)Compared to patients with acute ischemic stroke without atrial fibrillation,the patients with acute ischemic stroke with the atrial fibrillation show no significant difference in the prognosis rate of 7 days after mechanical thrombectomy.There is an increasing trend in the rate of poor prognosis of 90 days after mechanical thrombectomy.(2)Preoperative NIHSS score is an independent risk factor for early prognosis.Postoperative dual-antibody or double anti-poly drug is an independent protective factor for early prognosis.Preoperative NIHSS score and number of tethers are independent risk factor for prognosis at 90 days postoperatively.Taking dual anti-poly drugs after surgery is an independent protective factor for prognosis at 90 days postoperatively.(3)In patients with acute stroke with atrial fibrillation,blood stasis syndrome is more common.Different TCM syndromes had no effect on the early and long-term prognosis of patients with acute stroke with or without atrial fibrillation.