老年房颤患者前循环急性缺血性脑卒中机械取栓预后分析
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1.南京医科大学第一附属医院;2.南京医科大学第一附属医院心血管内科

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江苏省重点研发专项资金(ID: BE2017750)


Prognosis after mechanical thrombectomy in elderly atrial fibrillation patients with anterior-circulation acute ischemic stroke
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The First Affiliated Hospital of Nanjing Medical University

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The Key Clinical Study Project of Jiangsu Province

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    摘要:

    目的:评估因前循环大血管闭塞导致的急性缺血性脑卒中合并房颤的老年患者取栓治疗的临床结局及影响因素。方法: 2019年1月至2021年7月,前循环大血管闭塞且合并房颤的老年患者(≥80岁)被纳入研究。主要终点为90天改良Rankin评分(mRS)。次要终点包括全因死亡率、血管再通等级和颅内出血转化。采用多因素logistic回归分析影响临床预后的因素。结果:最终纳入74例符合入排标准的患者。良好预后(90天mRS 0-2分)率为21.6%,血流良好再通(mTICI 2b-3级)比例为77%,全因死亡率为36.4%,颅内出血转化率为35.1%。多因素logistic回归分析显示,非阵发性心房颤动(OR: 18.35, 95% CI: 1.98-169.77, p=0.010)、基线NIHSS评分(OR: 1.42, 95% CI: 1.15-1.75, p<0.001)、总流程时长(OR: 1.01, 95% CI: 1.00-1.02, p=0.030)是老年房颤患者机械取栓预后的独立危险因素。结论:老年房颤患者前循环急性缺血性脑卒中时,如合并基线NIHSS评分高和/或非阵发性房颤时,选择取栓治疗要更慎重。此外,需进一步提高老年房颤患者的抗凝率预防脑卒中。

    Abstract:

    Objective: To evaluate the clinical outcomes after mechanical thrombectomy (MT) in elderly atrial fibrillation (AF) patients with anterior-circulation large vessel occlusion (LVO)-related acute ischemic stroke (AIS). Methods: Between January 2019 and July 2021, consecutive elderly (≥80 year) AF patients who received MT due to anterior-circulation stroke were enrolled. The primary outcome was modified Rankin scale (mRS) score at 90 days. Secondary outcomes included all-cause mortality, the recanalization status after MT (assessed using modified thrombolysis in cerebral infarction scale, mTICI) and any intracranial hemorrhage (ICH). A multivariable logistic regression model was performed to identify predictors of the functional outcome. Results: A total of 74 eligible patients were finally enrolled. The proportion of patients with mRS score 0-2 at 90 days after stroke was 21.6%. The rate of satisfied recanalization with mTICI 2b-3 was 77%. The rate of all-cause mortality and intracranial hemorrhage during 90 days after stroke was 36.4% and 35.1%, respectively. A multivariable logistic regression analysis showed that non-paroxysmal atrial fibrillation (OR: 18.35, 95%CI: 1.98-169.77, p=0.010), baseline NIHSS score (OR: 1.42, 95%CI: 1.15-1.75, p<0.001), total procedure time (OR: 1.01, 95%CI: 1.00-1.02, p=0.030) were independent risk factors for poor prognosis. Conclusions: MT treatment in elderly AF patients with AIS should be performed with caution, especially in those with high NIHSS score and/or non-paroxysmal AF. In addition, efforts should be made to improve the anticoagulant rate of elderly patients with AF to prevent stroke.

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  • 收稿日期:2021-12-02
  • 最后修改日期:2021-12-17
  • 录用日期:2022-02-25
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