Atrial fibrillation is associated with increased in-hospital mortality and complications after IV t-PA in acute ischemic stroke: evidence from the China Stroke Center Alliance (CSCA)

Background and purpose Regarding the prognosis of patients with acute ischemic stroke (AIS) complicated by atrial fibrillation (AF) after thrombolysis, previous studies have reported conflicting results. This research investigates the connection between AF and in-hospital mortality following intravenous thrombolysis (IVT) in individuals with AIS. Methods Patient data were obtained from the Chinese Stroke Center Alliance (CSCA). This study constitutes a multicenter, retrospective cohort analysis, focusing on patients who received IVT using t-PA following an AIS. The primary outcome is adverse functional outcomes, characterized by in-hospital mortality. Safety outcomes mainly include cerebral hemorrhage. Univariate and multivariate logistic regression analyses were used to evaluate the relationship between AF and IVT outcomes. Results A total of 48,294 patients participated in the study, including 5,465 with a history of AF. Baseline characteristics indicated that patients in the AF group were of advanced age at the time of onset (74 years vs. 65 years, p < 0.001). The NIHSS score at admission was higher (11 vs. 5, p < 0.001), and a modified Rankin Scale (mRS) score ≥3 before admission was more common (28.7% vs. 24.8%, p < 0.001). Regarding safety results, patients suffering from AF had higher in-hospital mortality (3.1% vs. 0.8%; adjusted OR 1.77, 95% CI 1.41–2.23). Conclusion The study highlights that having a past of AF is linked to a higher chance of cerebral hemorrhage and in-hospital mortality in Chinese AIS patients following IVT. AF history is a strong predictor of in-hospital mortality (AUC = 0.85).