Comparison of functional outcomes after endovascular thrombectomy in patients with and without atrial fibrillation

Fu, James C.; Cappelen‐Smith, Cecilia; Edwards, Leon; Cheung, Andrew; Manning, Nathan; Wenderoth, Jason; Parsons, Mark; Cordato, Dennis

doi:10.20517/2574-1209.2021.36

Cited by 9 publications

(35 citation statements)

References 32 publications

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“…Previous studies have reported that AF is significantly associated with worse 90-day outcomes, higher rates of mortality, and comparable rates of successful reperfusion. [14][15][16][17][18][19][20][21][22][23][24] Yet, these previous studies were individually much smaller than the cohort included in our pooled analysis. Interestingly, 1 study 18 included in our analysis could be considered an outlier regarding functional independence rates.…”

Section: Discussionmentioning

confidence: 99%

“…The size of the included studies ranged from 78 patients to 4169 patients. Eight studies [14][15][16][17][19][20][21]23 included in our analysis were determined to have good quality, while 2 studies 18,22 were determined to have fair quality (eTable in Supplement 1). Patient characteristics, such as age, baseline NIHSS, use of intravenous thrombolytics, and comorbidities, are detailed in the Table.…”

Section: Study Characteristics and Risk Of Biasmentioning

confidence: 99%

“…Successful reperfusion rates (defined as TICI score 2b-3) were reported in 9 studies [14][15][16][17][18][20][21][22][23] including 5577 AIS patients who underwent MT. Successful reperfusion rates were similar between patients with and without AF (OR, 1.11 [95% CI, 0.78-1.58]; P = .57); however, there was significant heterogeneity among studies (I 2 = 56%; P = .02) (Figure 2A).…”

Section: Successful Reperfusionmentioning

confidence: 99%

“…Nine studies [14][15][16][17][18][19][20][21]23 with 5614 patients compared the rates of SICH after MT between patients with and without AF. Rates of SICH were comparable between groups (OR, 1.05 [95% CI, 0.84-1.31]; P = .68), with no heterogeneity observed across studies (I 2 = 0%; P = .75) (Figure 3).…”

Section: Sich and Mortality Ratesmentioning

confidence: 99%

“…Ten studies [14][15][16][17][18][19][20][21][22][23] with 6131 patients compared the rates of 90-day mortality between patients with and without AF. Mortality was significantly higher in the AF group (OR, 1.47 [95% CI, 1.12-1.92]; P = .005), with no significant heterogeneity observed (I 2 = 42%; P = .08) (Figure 4).…”

Section: Sich and Mortality Ratesmentioning

confidence: 99%

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Outcomes of Patients With Atrial Fibrillation Following Thrombectomy for Stroke

et al. 2023

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ImportancePatients with atrial fibrillation (AF) treated with mechanical thrombectomy (MT) for acute ischemic stroke (AIS) have been reported to experience worse outcomes compared with patients without AF.ObjectiveTo assess differences between patients with AF and their counterparts without AF treated with MT for AIS, focusing on safety outcomes, clinical outcomes, and baseline characteristics in both groups.Data SourcesA systematic literature review of the English language literature from inception to July 14, 2022, was conducted using Web of Science, Embase, Scopus, and PubMed databases.Study SelectionStudies that focused on patients with and without AF treated with MT for AIS were included. Multiple reviewers screened studies to identify studies included in analysis.Data Extraction and SynthesisData were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline to ensure accuracy. Data were pooled using a random-effects model.Main Outcomes and MeasuresThe primary outcome of interest was rate of modified Rankin Scale (mRS) scores of 0 to 2 at 90 days. Secondary outcomes of interest included rates of successful reperfusion, defined as thrombolysis in cerebral infarction (TICI) scores of 2b to 3, 90-day mortality, symptomatic intracranial hemorrhage (SICH), and baseline patient characteristics.ResultsOf 1696 initially retrieved studies, 10 studies were included, with 6543 patients. Patients with AF were a mean of 10.17 (95% CI, 8.11-12.23) years older (P &lt; .001) and had higher rates of hypertension (OR, 1.89 [95% CI, 1.57-2.27]; P &lt; .001) and diabetes (OR, 1.16 [95% CI, 1.02-1.31]; P = .02). Overall, there were comparable rates of mRS scores of 0 to 2 between patients with AF and patients without AF (odds ratio [OR], 0.72 [95% CI, 0.47-1.10]; P = .13), with significant heterogeneity among the included studies. After sensitivity analysis, the rate of mRS scores of 0 to 2 was significantly lower among patients with AF (OR, 0.65 [95% CI, 0.52-0.81]; P &lt; .001). Successful reperfusion rates were similar between the groups (OR, 1.11 [95% CI, 0.78-1.58]; P = .57). The rate of SICH was similar between groups (OR, 1.05 [95% CI, 0.84-1.31]; P = .68). Mortality was significantly higher in the AF group (OR, 1.47 [95% CI, 1.12-1.92]; P = .005).Conclusions and RelevanceIn this systematic review and meta-analysis, patients with AF experienced worse 90-day outcomes, even in the setting of similar rates of successful reperfusion. This was likely associated with greater age and greater rates of comorbidities among patients with AF.

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