Effect of atrial fibrillation on endovascular thrombectomy for acute ischemic stroke. A meta-analysis of individual patient data from six randomised trials : Results from the HERMES collaboration
Smaal, J. A. (Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM))
de Ridder, I. R. (Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM))
Heshmatollah, A. (Erasmus MC University Medical Center)
van Zwam, W. H. (Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM))
Dippel, DWJ (Erasmus MC University Medical Center)
Majoie, C. B. (Amsterdam UMC. University Medical Center)
Brown, S. (Altair Biostatistics)
Goyal, M. (University of Calgary, Foothills Hospital)
Campbell, Bruce C.V (Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne)
Muir, Keith W. (Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital)
Demchuck, A. M. (University of Calgary, Foothills Hospital)
Dávalos, Antoni (Universitat Autònoma de Barcelona. Departament de Medicina)
Jovin, T. G. (Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center)
Mitchell, P. J. (Royal Melbourne Hospital (Melbourne, Austràlia))
White, Philip (Institute of Neuroscience, Newcastle University)
Saver, J. L. (Department of Neurology, Amsterdam University Medical Centers)
Hill, M. D. (Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital)
Roos, Y. B. (Department of Neurology, Amsterdam University Medical Centers)
van der Lugt, A. (Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center)
van Oostenbrugge, R. J. (Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM))

Fecha:	2020
Resumen:	Atrial fibrillation is an important risk factor for ischemic stroke, and is associated with an increased risk of poor outcome after ischemic stroke. Endovascular thrombectomy is safe and effective in acute ischemic stroke patients with large vessel occlusion of the anterior circulation. This meta-analysis aims to investigate whether there is an interaction between atrial fibrillation and treatment effect of endovascular thrombectomy, and secondarily whether atrial fibrillation is associated with worse outcome in patients with ischemic stroke due to large vessel occlusion. Individual patient data were from six of the recent randomised clinical trials (MR CLEAN, EXTEND-IA, REVASCAT, SWIFT PRIME, ESCAPE, PISTE) in which endovascular thrombectomy plus standard care was compared to standard care alone. Primary outcome measure was the shift on the modified Rankin scale (mRS) at 90 days. Secondary outcomes were functional independence (mRS 0-2) at 90 days, National Institutes of Health Stroke Scale score at 24 h, symptomatic intracranial hemorrhage and mortality at 90 days. The primary effect parameter was the adjusted common odds ratio, estimated with ordinal logistic regression (shift analysis); treatment effect modification of atrial fibrillation was assessed with a multiplicative interaction term. Among 1351 patients, 447 patients had atrial fibrillation, 224 of whom were treated with endovascular thrombectomy. We found no interaction of atrial fibrillation with treatment effect of endovascular thrombectomy for both primary (p -value for interaction: 0. 58) and secondary outcomes. Regardless of treatment allocation, we found no difference in primary outcome (mRS at 90 days: aOR 1. 11 (95% CI 0. 89-1. 38) and secondary outcomes between patients with and without atrial fibrillation. We found no interaction of atrial fibrillation on treatment effect of endovascular thrombectomy, and no difference in outcome between large vessel occlusion stroke patients with and without atrial fibrillation.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució i la comunicació pública de l'obra, sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Ischemic stroke ; Endovascular thrombectomy ; Atrial fibrillation ; Large vessel occlusion
Publicado en:	European Stroke Journal, Vol. 5 (may 2020) , p. 245-251, ISSN 2396-9881

DOI: 10.1177/2396987320923447
PMID: 33072878

7 p, 570.4 KB

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