An in-depth analysis of the clinical outcome of ischemic stroke patients with atrial fibrillation

Abstract

Abstract Background Atrial fibrillation (AF) increases the risk of ischemic stroke (IS) in the general population. We sought to obtain the association of in-hospital mortality, stroke severity, and other clinic parameters with AF in IS patients. Methods We retrospectively analyzed the patients with acute IS in our hospital. They were divided into 2 groups: the AF group and the non-AF group. All patients received cranial computed tomography or magnetic resonance imaging (MRI) within 2 weeks of the onset of clinical symptoms. All patients were evaluated for stroke severity using the National Institute of Health Stroke Scale (NIHSS) score. Multivariate logistic regression was used to determine whether AF was associated with stroke severity and in-hospital death. A propensity score-matched analysis was used to estimate differences in severity and infarct volume between the two groups. Result The study cohort included 586 patients (AF group: n = 190, 103 female, median age = 80 years; non-AF group: n = 396, 182 female, median age = 68 years). Compared with non-AF group, AF group had higher admission and discharge NIHSS scores (median, 11 vs 3, and 7 vs 2; both P < 0.0001), longer hospital stays (median, 11 vs 10 days; P = 0.001), higher in-hospital mortality rate (24.2% vs 4.8%, P < 0.0001), and higher hospitalization costs [19182.64(11368.45,40808.35) vs 13329.54(10850.33,18629.34), China Yuan (CNY); P < 0.0001]. Multivariate logistic regression analyses found that AF was an independent risk factor for severe stroke (NIHSS score, ≥ 16) and inpatient death. In the two groups after a propensity score matching, the AF group had greater infarct volume [25.8(7.9–83.8) vs 1.4 (0.7–9.5) ml; P < 0.0001]. Conclusions AF was associated with higher inpatient mortality, greater infarction volume, worse neurological deficits, and higher hospital cost. AF should be considered an independent risk factor for worse clinical outcomes in the IS patient.