Journal Article

Baseline brain imaging signs in patients with ischaemic stroke by the presence of atrial fibrillation: the ENCHANTED trial

Carcel, Cheryl, Lindley, Richard I., Malavera, Alejandra, Yoshimura, Sohei, You, Shoujiang, Mair, Grant, Delcourt, Candice, Robinson, Thompson, Anderson, Craig, Chen, Xiaoying, Wang, Xia, Torii-Yoshimura, Takako, Zhou, Zien, Wardlaw, Joanna

2023

Overview

Background We aimed to assess the association of atrial fibrillation (AF) on outcomes in a post hoc analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) and how this association is modified by baseline imaging features. Methods Inverse probability of treatment weight was used to remove baseline imbalances between those with and without AF. The primary outcome was the modified Rankin Scale (mRS) scores at 90 days. Secondary outcomes were symptomatic intracerebral haemorrhage (sICH), early neurological deterioration or death within 24 h, and death at 90 days. The logistic regression model was used to determine the associations. Results Of the 3285 patients included in this analysis, 636 (19%) had AF at baseline. Compared with non-AF, AF was not significantly associated with an unfavourable shift of mRS (odds ratio 1.09; 95% confidence interval, 0.96–1.24), but with sICH (2.82; 1.78-4.48; IST-3 criteria), early neurological deterioration or death within 24 h (1.31; 1.01-1.70), and death (1.42; 1.12-1.79). Among patients with acute ischaemic signs (presence, extent, swelling and attenuation of acute lesions), AF was associated with the increased risk of all the poor outcomes (all P  < 0.04 for interaction). Conclusions We found AF increased risk of sICH, early neurological deterioration or death and death, but not unfavourable functional recovery at day 90 after thrombolysis in patients with AIS. The presence of acute ischaemic brain imaging signs at stroke presentation could be used to improve risk stratification in the presence of AF. Trial registration The trial is registered at ClinicalTrials.gov (NCT01422616).

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Atrial Fibrillation - complications / Atrial Fibrillation - diagnostic imaging / Atrial Fibrillation - drug therapy / Brain Ischemia - complications / Brain Ischemia - diagnostic imaging / Brain Ischemia - drug therapy / Cardiac arrhythmia / Cerebral Hemorrhage - complications / Death / Fibrillation / Fibrinolytic Agents - therapeutic use / Hemorrhage / Humans / Ischemia / Ischemic Stroke - complications / Medical imaging / Medicine / Medicine & Public Health / NCT / NCT01422616 / Neuroimaging / Neurology / Neuroradiology / Neurosciences / Original Communication / Recovery of function / Stroke / Stroke - complications / Stroke - diagnostic imaging / Stroke - drug therapy / Thrombolysis / Thrombolytic drugs / Thrombolytic Therapy - adverse effects / Tissue Plasminogen Activator - therapeutic use / Treatment Outcome