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Published on: February 26, 2013
Predictors of ischemic stroke severity and long-term functional outcomes in patients with and without atrial
Meng-Ying Lu1, Kuo-Hua Hung2, Chih-Min Hu2
1Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung, Taiwan, Republic of China; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, Republic of China.
Insights
Predictors of stroke severity and outcomes differ between patients with and without atrial fibrillation (AF). Understanding these differences is key for tailored secondary prevention and post-stroke management in ischemic stroke patients.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Atrial fibrillation (AF) is a common comorbidity in ischemic stroke patients, potentially influencing stroke mechanisms and prognosis.
- Existing research often treats stroke patients uniformly, overlooking AF-specific differences in stroke severity and functional outcomes.
Purpose of the Study:
- To investigate predictors of initial stroke severity and 3-month functional outcomes in first-ever ischemic stroke.
- To stratify these predictors based on the presence or absence of atrial fibrillation (AF).
Main Methods:
- Analysis of consecutive first-ever acute ischemic stroke patients admitted within 7 days of onset.
- Evaluation of admission National Institutes of Health Stroke Scale (NIHSS) and 3-month modified Rankin Scale (mRS) scores.
- Multivariable general linear models were used, stratified by AF status, with adjustment for admission NIHSS for 3-month mRS models.
Main Results:
- Patients with AF were older, with higher admission NIHSS and 3-month mRS scores compared to non-AF patients.
- In non-AF patients, predictors of higher NIHSS included age ≥75, betel nut chewing, and sedentary lifestyle. In AF patients, sedentary lifestyle predicted higher NIHSS.
- Type 2 diabetes was associated with higher 3-month mRS in both groups. Age ≥75 and sedentary lifestyle predicted higher 3-month mRS only in the non-AF group.
Conclusions:
- Predictors for initial stroke severity and 3-month functional outcomes vary significantly depending on atrial fibrillation status.
- Stratified prognostic assessment is crucial for guiding individualized secondary prevention strategies and post-stroke management in ischemic stroke patients.
Background:
Ischemic stroke patients with atrial fibrillation (AF) may have different mechanisms and prognostic determinants than those without AF. We investigated predictors of initial stroke severity and 3-month functional outcome in first-ever ischemic stroke, stratified by AF status.
Methods:
Consecutive patients with first-ever acute ischemic stroke admitted within 7 days of onset to Taitung MacKay Memorial Hospital from December 31, 2014, to December 31, 2020, were analyzed. Admission National Institutes of Health Stroke Scale (NIHSS) and 3-month modified Rankin Scale (mRS) scores were evaluated using multivariable general linear models stratified by AF status. The 3-month mRS models assessed whether associations persisted after adjustment for admission NIHSS.
Results:
Overall, 1256 patients were included (non-AF, n = 955; AF, n = 301). Patients with AF were older and had higher admission NIHSS and 3-month mRS scores than those without AF. In the non-AF group, age ≥75 years, betel nut chewing, and sedentary lifestyle were associated with higher admission NIHSS, whereas dyslipidemia was associated with lower admission NIHSS. In the AF group, sedentary lifestyle was associated with higher admission NIHSS, whereas obesity and pre-stroke anticoagulant therapy were associated with lower admission NIHSS. After adjustment for admission NIHSS, type 2 diabetes was independently associated with higher 3-month mRS in both groups. Age ≥75 years and sedentary lifestyle remained associated with higher 3-month mRS only in the non-AF group.
Conclusion:
Predictors of initial stroke severity and 3-month functional outcome differ by AF status. Stratified prognostic assessment may guide individualized secondary prevention and post-stroke management.
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