Endovascular thrombectomy in patients with acute ischaemic stroke and atrial fibrillation: a MR CLEAN subgroup analysis

Alis Heshmatollah; Puck S. S. Fransen; Olvert A. Berkhemer; Debbie Beumer; Aad van der Lugt; Charles B. L. M. Majoie; Robert J. Oostenbrugge; Wim H. van Zwam; Peter J. Koudstaal; Yvo B. W. E. M. Roos; Diederik W. J. Dippel; MR CLEAN Investigators

doi:10.4244/EIJ-D-16-00905

Endovascular thrombectomy in patients with acute ischaemic stroke and atrial fibrillation: a MR CLEAN subgroup analysis

Alis Heshmatollah^*, Puck S. S. Fransen, Olvert A. Berkhemer, Debbie Beumer, Aad van der Lugt, Charles B. L. M. Majoie, Robert J. Oostenbrugge, Wim H. van Zwam, Peter J. Koudstaal, Yvo B. W. E. M. Roos, Diederik W. J. Dippel, MR CLEAN Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Aims: Endovascular thrombectomy (EVT) improves outcome after acute ischaemic stroke (AIS) caused by an intracranial occlusion. The aim of the present study was to determine whether atrial fibrillation (AF) modifies the effect of EVT.

Methods and results: MR CLEAN was a randomised clinical trial of EVT plus usual care vs. usual care alone for patients with an intracranial occlusion. The primary outcome was the modified Rankin scale (mRS) score at 90 days. The primary effect parameter was the adjusted common odds ratio (acOR), estimated with ordinal logistic regression and adjusted for age and stroke severity at baseline. Treatment effect modification by AF was assessed using a multiplicative interaction variable. We included all 500 patients. In total, 135 (27%) had AF. These patients were older, had a worse pre-stroke mRS score and were less often treated with IV alteplase. In patients without AF, the estimated treatment effect was similar to the overall treatment effect (acOR 1.9, 95% CI: 1.3 to 2.7). In patients with AF, the treatment effect appeared lower (acOR 1.0, 95% CI: 0.6 to 1.9). The interaction of treatment effect and AF was not significant (p=0.09, after adjustment p=0.12).

Conclusions: This study did not show significant difference in the EVT effect between acute stroke patients with and those without AF.

Original language	English
Pages (from-to)	996-1002
Number of pages	7
Journal	Eurointervention
Volume	13
Issue number	8
DOIs	https://doi.org/10.4244/EIJ-D-16-00905
Publication status	Published - Oct 2017

Keywords

atrial fibrillation
clinical research
stroke
thrombus-containing lesion
INTRAVENOUS T-PA
THROMBOLYSIS
THERAPY
TRIALS

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10.4244/EIJ-D-16-00905

Cite this

Heshmatollah, A., Fransen, P. S. S., Berkhemer, O. A., Beumer, D., van der Lugt, A., Majoie, C. B. L. M., Oostenbrugge, R. J., van Zwam, W. H., Koudstaal, P. J., Roos, Y. B. W. E. M., Dippel, D. W. J., & MR CLEAN Investigators (2017). Endovascular thrombectomy in patients with acute ischaemic stroke and atrial fibrillation: a MR CLEAN subgroup analysis. Eurointervention, 13(8), 996-1002. https://doi.org/10.4244/EIJ-D-16-00905

@article{89ce4e48bb124536b46b6780e970b666,

title = "Endovascular thrombectomy in patients with acute ischaemic stroke and atrial fibrillation: a MR CLEAN subgroup analysis",

abstract = "Aims: Endovascular thrombectomy (EVT) improves outcome after acute ischaemic stroke (AIS) caused by an intracranial occlusion. The aim of the present study was to determine whether atrial fibrillation (AF) modifies the effect of EVT.Methods and results: MR CLEAN was a randomised clinical trial of EVT plus usual care vs. usual care alone for patients with an intracranial occlusion. The primary outcome was the modified Rankin scale (mRS) score at 90 days. The primary effect parameter was the adjusted common odds ratio (acOR), estimated with ordinal logistic regression and adjusted for age and stroke severity at baseline. Treatment effect modification by AF was assessed using a multiplicative interaction variable. We included all 500 patients. In total, 135 (27%) had AF. These patients were older, had a worse pre-stroke mRS score and were less often treated with IV alteplase. In patients without AF, the estimated treatment effect was similar to the overall treatment effect (acOR 1.9, 95% CI: 1.3 to 2.7). In patients with AF, the treatment effect appeared lower (acOR 1.0, 95% CI: 0.6 to 1.9). The interaction of treatment effect and AF was not significant (p=0.09, after adjustment p=0.12).Conclusions: This study did not show significant difference in the EVT effect between acute stroke patients with and those without AF.",

keywords = "atrial fibrillation, clinical research, stroke, thrombus-containing lesion, INTRAVENOUS T-PA, THROMBOLYSIS, THERAPY, TRIALS",

author = "Alis Heshmatollah and Fransen, {Puck S. S.} and Berkhemer, {Olvert A.} and Debbie Beumer and {van der Lugt}, Aad and Majoie, {Charles B. L. M.} and Oostenbrugge, {Robert J.} and {van Zwam}, {Wim H.} and Koudstaal, {Peter J.} and Roos, {Yvo B. W. E. M.} and Dippel, {Diederik W. J.} and {MR CLEAN Investigators}",

year = "2017",

month = oct,

doi = "10.4244/EIJ-D-16-00905",

language = "English",

volume = "13",

pages = "996--1002",

journal = "Eurointervention",

issn = "1774-024X",

publisher = "Europa Digital & Publishing",

number = "8",

}

Heshmatollah, A, Fransen, PSS, Berkhemer, OA, Beumer, D, van der Lugt, A, Majoie, CBLM, Oostenbrugge, RJ , van Zwam, WH, Koudstaal, PJ, Roos, YBWEM, Dippel, DWJ & MR CLEAN Investigators 2017, 'Endovascular thrombectomy in patients with acute ischaemic stroke and atrial fibrillation: a MR CLEAN subgroup analysis', Eurointervention, vol. 13, no. 8, pp. 996-1002. https://doi.org/10.4244/EIJ-D-16-00905

TY - JOUR

T1 - Endovascular thrombectomy in patients with acute ischaemic stroke and atrial fibrillation

T2 - a MR CLEAN subgroup analysis

AU - Heshmatollah, Alis

AU - Fransen, Puck S. S.

AU - Berkhemer, Olvert A.

AU - Beumer, Debbie

AU - van der Lugt, Aad

AU - Majoie, Charles B. L. M.

AU - Oostenbrugge, Robert J.

AU - van Zwam, Wim H.

AU - Koudstaal, Peter J.

AU - Roos, Yvo B. W. E. M.

AU - Dippel, Diederik W. J.

AU - MR CLEAN Investigators

PY - 2017/10

Y1 - 2017/10

N2 - Aims: Endovascular thrombectomy (EVT) improves outcome after acute ischaemic stroke (AIS) caused by an intracranial occlusion. The aim of the present study was to determine whether atrial fibrillation (AF) modifies the effect of EVT.Methods and results: MR CLEAN was a randomised clinical trial of EVT plus usual care vs. usual care alone for patients with an intracranial occlusion. The primary outcome was the modified Rankin scale (mRS) score at 90 days. The primary effect parameter was the adjusted common odds ratio (acOR), estimated with ordinal logistic regression and adjusted for age and stroke severity at baseline. Treatment effect modification by AF was assessed using a multiplicative interaction variable. We included all 500 patients. In total, 135 (27%) had AF. These patients were older, had a worse pre-stroke mRS score and were less often treated with IV alteplase. In patients without AF, the estimated treatment effect was similar to the overall treatment effect (acOR 1.9, 95% CI: 1.3 to 2.7). In patients with AF, the treatment effect appeared lower (acOR 1.0, 95% CI: 0.6 to 1.9). The interaction of treatment effect and AF was not significant (p=0.09, after adjustment p=0.12).Conclusions: This study did not show significant difference in the EVT effect between acute stroke patients with and those without AF.

AB - Aims: Endovascular thrombectomy (EVT) improves outcome after acute ischaemic stroke (AIS) caused by an intracranial occlusion. The aim of the present study was to determine whether atrial fibrillation (AF) modifies the effect of EVT.Methods and results: MR CLEAN was a randomised clinical trial of EVT plus usual care vs. usual care alone for patients with an intracranial occlusion. The primary outcome was the modified Rankin scale (mRS) score at 90 days. The primary effect parameter was the adjusted common odds ratio (acOR), estimated with ordinal logistic regression and adjusted for age and stroke severity at baseline. Treatment effect modification by AF was assessed using a multiplicative interaction variable. We included all 500 patients. In total, 135 (27%) had AF. These patients were older, had a worse pre-stroke mRS score and were less often treated with IV alteplase. In patients without AF, the estimated treatment effect was similar to the overall treatment effect (acOR 1.9, 95% CI: 1.3 to 2.7). In patients with AF, the treatment effect appeared lower (acOR 1.0, 95% CI: 0.6 to 1.9). The interaction of treatment effect and AF was not significant (p=0.09, after adjustment p=0.12).Conclusions: This study did not show significant difference in the EVT effect between acute stroke patients with and those without AF.

KW - atrial fibrillation

KW - clinical research

KW - stroke

KW - thrombus-containing lesion

KW - INTRAVENOUS T-PA

KW - THROMBOLYSIS

KW - THERAPY

KW - TRIALS

U2 - 10.4244/EIJ-D-16-00905

DO - 10.4244/EIJ-D-16-00905

M3 - Article

C2 - 28649948

SN - 1774-024X

VL - 13

SP - 996

EP - 1002

JO - Eurointervention

JF - Eurointervention

IS - 8

ER -