Background: Based on literature, it was not clear whether patients with active atrial fibrillation (AF) at the time stroke would have poorer outcomes. In this study, we aimed to compare the outcomes the group of patients with active AF with other group with history of AF at the time of stroke.
Methods: We retrospectively identified acute ischemic stroke patients presenting to our stroke centre from January 2015 to December 2016 within 3 days onset of stroke symptoms. Presenting characteristics, baseline NIHSS score, symptomatic intracranial haemorrhage (sICH)(ECASS III criterion) rate, and mortality rate in 30 days was compared. Multivariate analyses were performed.
Results: A total of 863 acute ischemic stroke patients were included. Of those, 135(15.64%) patients had AF history; 125 (14.48%) patients with active AF confirmed by Electrocardiogram in the emergency room. Except the hypertension history, other basic character of each group had no significant difference. The sICH rate in 7 days was 3.24% in total, and 8.89% (p<0.001, compared with total) in AF history patients, 9.6% (p<0.001, compared with total) in active AF patients. The mortality rate in 30 days was 10.8% in total, and 16.3% (p<0.001, compared with total) in AF history patients, 25.6% (p<0.001, compared with total) in active AF patients. Further, according to the AF condition, we separate patients with AF into three groups: the patients with AF history accompanied with active AF(AF&active-AF, n=87); the patients with AF history without active AF (AF, n=48); the patients with active AF without AF history (active-AF, n=38). The baseline NIHSS score was higher in the AF&active-AF patients (13.85±8.75, p<0.05 ). The mortality rate in 30 days was higher in the active-AF patients (28.9%, p<0.05), and lowest in the AF patients (2.08%, p<0.05). There is no difference in the rate of sICH among three groups. AF onset confirmed by Electrocardiogram in emergency independently predicted 30-day death rate (p=0.004).
Conclusions: Active atrial fibrillation at the time of stroke is a strong predictor of post-stroke death in 30 days.