心房颤动相关心源性脑梗死再灌注治疗临床结局的影响因素分析OACSTPCD

Objective Analysis of risk factors influencing poor clinical outcomes of reperfusion therapy for atrial fibrillation-related cardiogenic cerebral infarction.Methods Patients with reperfusion therapy for atrial fibrillation-related cardiogenic cerebral infarction(including intravenous thrombolysis alone,mechanical thrombolysis,and bridging therapy)at the stroke centers of the First Affiliated Hospital of Soochow University and Jiangyin People's Hospital were retrospectively consecutively enrolled from September 2018 to September 2020.Detailed patient data were collected,including gender,age,and history(hypertension,diabetes mellitus,hyperlipidemia,ischemic stroke,coronary artery disease,chronic heart failure,and history of smoking);indicators of admission tests(time from first detection of abnormality to the emergency room,systolic blood pressure,diastolic blood pressure,and the National Institutes of Health stroke scale[NIHSS]score)and pre-treatment laboratory test results(random blood glucose,D-dimer,ultrasensitive C-reactive protein,N-terminal B-type natriuretic peptide proteins[NT-proBNP],and fibrinogen);the site of the responsible vessel(anterior,posterior,and anterior-posterior circulation)was differentiated based on the patient's head-and-neck CT angiography plus CT perfusion imaging,and the relevant imaging parameters(infarct core volume and ischemic semidarkness zone volume)were collected.Time from admission to intravenous thrombolysis was collected in patients treated with intravenous thrombolysis alone and bridging therapy,and time from admission to arterial puncture and revascularization after thrombolysis therapy(modified Thrombolysis in Cerebral Infarction[mTICI]classification)were collected in patients treated with mechanical thrombolysis and bridging.Information of patients at discharge were collected(NIHSS score at discharge).Patients were categorized into poor outcome(mRS score of 3-6)and good outcome(mRS score of 0-2)groups according to their mRS scores at 90 d follow-up after discharge.Factors affecting the outcome after reperfusion therapy for atrial fibrillation-related cardiogenic cerebral infarction were screened by multifactorial Logistic regression analysis,receiver operating characteristic(ROC)curves were generated separately,and the area under the curve was calculated to explore the predictive value for poor outcome.Results A total of 152 patients with reperfusion therapy for atrial fibrillation-associated cardiogenic cerebral infarction were included,including 86 males and 66 females;age ranged from 38 to 91 years,with a mean of(73±10)years.There were 52 cases of intravenous thrombolysis alone,24 cases of mechanical thrombolysis alone,and 76 cases of bridging therapy.There were 69 patients with poor outcome after reperfusion therapy(poor outcome group)and 83 patients with good outcome(good outcome group),and the differences in age,diabetes mellitus,time from first abnormality detection to the emergency room,admission systolic blood pressure,admission diastolic blood pressure,admission NIHSS scores,and pre-treatment levels of D-dimer,ultrasensitive C-reactive protein,and NT-proBNP were statistically significant between the two groups(all P＜0.05);in terms of CT perfusion parameters,the poor outcome group had a larger infarct core(49[20,84]ml vs.8[2,19]ml,Z=-7.049,P＜0.01)and ischemic penumbra volume(64[107,243]ml vs.55[17,131]ml,Z =-6.128,P＜0.01).Multifactorial Logistic regression analysis showed that independent influences on the poor outcome of reperfusion therapy for atrial fibrillation-related cardiogenic cerebral infarction included admission NIHSS score(OR,1.203,95%CI 1.085-1.334,P＜0.01),and infarct core volume(OR,1.048,95%CI 1.023-1.073,P＜0.01).The area under the ROC curve for the combined admission NIHSS score and infarct core volume was 0.897(P＜0.01).Conclusion Independent risk factors affecting poor outcome after reperfusion therapy for atrial fibrillation-associated cardiogenic cerebral infarction include admission NIHSS score and infarct core volume,and the combined admission NIHSS score and infarct core volume can be a useful predictor of patients with poor outcome.