Reperfusion therapies in patients with acute ischaemic stroke and atrial fibrillation: data on safety and effectiveness from a multi-centre cohort study
Authors: Cancelloni Virginia , Buratti Mariachiara , Tsivgoulis Georgios , Furie Karen L. , Tadi Prasanna , Caso Valeria , Becattini Cecilia , Agnelli Giancarlo , Zedde Marialuisa , Abdul-Rahim Azmil H. , Alberti Andrea , Venti Michele , de Magistris Ilaria Leone , Acciarresi Monica , D’Amore Cataldo , Mosconi Maria G. , Cimini Ludovica A. , Cappellari Manuel , Putaala Jukka , Tomppo Liisa , Tatlisumak Turgut , Bandini Fabio , Marcheselli Simona , Pezzini Alessandro , Sohn Sung-I. I. , Lorenzini Gianni , Tassi Rossana , Guideri Francesca , Acampa Maurizio , Ntaios George , Karagkiozi Efstathia , Athanasakis George , Makaritsis Kostantinos , Sagris Dimitrios , Adamou Anastasia , Vadikolias Kostantinos , Palaiodimou Lina , Chondrogianni Maria , Mumoli Nicola , Galati Franco , Sacco Simona , Tiseo Cindy , Corea Francesco , Ageno Walter , Bellesini Marta , Silvestrelli Giorgio , Ciccone Alfonso , Mancuso Michelangelo , Orlandi Giovanni , Pascarella Rosario , Tassinari Tiziana , Rueckert Christina , Baldi Antonio , Toni Danilo , Lettieri Federica , Giuntini Martina , Lotti Enrico M. , Flomin Yuriy , Pieroni Alessio , Kargiotis Odysseas , Karapanayiotides Theodore , Halvatsiotis Panagiotis , Monaco Serena , Baronello Mario M. , Csiba Laszlò , Szabò Lilla , Chiti Alberto , Giorli Elisa , Del Sette Massimo , Imberti Davide , Zabzuni Dorjan , Doronin Boris , Volodina Vera , Michel Patrik , Vanacker Peter , Barlinn Kristian , Pallesen Lars P. , Kepplinger Jessica , Deleu Dirk , Gourbali Vanessa , Yaghi Shadi , Paciaroni Maurizio ,   RAF, R. A. F.-NOACs Investigators
Published: May 2024

Abstract
Background
Intravenous thrombolysis (IVT) and/or endovascular therapy (EVT) are currently considered best practices in acute stroke patients. Data regarding the efficacy and safety of reperfusion therapies in patients with atrial fibrillation (AF) are conflicting as regards haemorrhagic transformation, mortality, and functional outcome. This study sought to investigate for any differences, in terms of safety and effectiveness, between AF patients with acute ischaemic stroke (AIS) treated and untreated with reperfusion therapies.

Methods
Data from two multicenter cohort studies (RAF and RAF-NOACs) on consecutive patients with AF and AIS were analyzed to compare patients treated and not treated with reperfusion therapies (IVT and/or EVT). Multivariable logistic regression analysis was performed to identify independent predictors for outcome events: 90-day good functional outcome and mortality. A propensity score matching (PSM) analysis compared treated and untreated patients.

Results
Overall, 441 (25.4%) were included in the reperfusion-treated group and 1,295 (74.6%) in the untreated group. The multivariable model suggested that reperfusion therapies were significantly associated with good functional outcome. Rates of mortality and disability were higher in patients not treated, especially in the case of higher NIHSS scores. In the PSM comparison, 173/250 patients (69.2%) who had received reperfusion therapies had good functional outcome at 90 days, compared to 146/250 (58.4%) untreated patients (p = 0.009, OR: 1.60, 95% CI:1.11–2.31).

Conclusions
Patients with AF and AIS treated with reperfusion therapies had a significantly higher rate of good functional outcome and lower rates of mortality compared to those patients with AF and AIS who had undergone conservative treatment.