The Study Of Atrial Fibrillation Predicting Hemorrhagic Transformation After Acute Ischemic Stroke

Objectives The study investigated that weather atrial fibrillation is an independent predictor of hemorrhagic transformation after acute ischemic stroke.Methods We studied 12415 acute ischemic stroke patients consecutively enrolled in the China National Stroke Registryâ… (CNSR-1) from September 2007 to August 2008. Hemorrhagic transformation was diagnosed based on the initial CT or MRI at admission, or subsequent reviewing CT or MRI after admission. Spontaneous hemorrhagic transformation was diagnosed based on the initial CT or MRI at admission. Atrial fibrillation was determined as self-reported history of atrial fibrillation, or confirmed by at least one electrocardiogram, or based on the treatments for atrial fibrillation. Multivariate Logistic regression models were used to analyze the association between atrial fibrillation and hemorrhagic transformation.Results 1 Of 12415 acute ischemic stroke patients, 251(2.0%) were found to have hemorrhagic transformation, and 114(0.9%) were found to have spontaneous hemorrhagic transformation. 2 In the multivariate Logistic regression model adjusted for age, gender, score of Glasgow Coma Scale(GCS), score of National Institutes of Health Stroke Scale(NIHSS), and other ten variables, atrial fibrillation was independently associated with hemorrhagic transformation(OR: 2.14, 95% CI: 1.47-3.12, P < 0.001). Additionally, period between stroke onset and admission more than one day, higher score of NIHSS, thrombolysis, cardioembolism of the TOAST classification were positively associated with hemorrhagic transformation, and small vessel occlusion of the TOAST classification was negatively associated with hemorrhagic transformation. 3 In the multivariate Logistic regression model adjusted for age, gender, score of GCS, score of NIHSS, and other ten variables, history of atrial fibrillation was independently associated with spontaneous hemorrhagic transformation(OR: 1.94, 95% CI: 1.04-3.59, P = 0.036). Additionally, female, period between stroke onset and admission more than 6 hours, higher score of NIHSS, and history of cerebral hemorrhage were positively associated with spontaneous hemorrhagic transformation, and history of diabetes was negatively associated with spontaneous hemorrhagic transformation.Conclusions 1 Hemorrhagic transformation occurred in 2.0% of the patients with acute ischemic stroke in the CNSR-1, and spontaneous hemorrhagic transformation occurred in 0.9%. 2 Atrial fibrillation is an independent predictor of hemorrhagic transformation after acute ischemic stroke. Combined with period between stroke onset and admission, score of NIHSS, thrombolysis, cardioembolism of the TOAST classification, atrial fibrillation could predict the incidence of hemorrhagic transformation. 3 History of atrial fibrillation is an independent predictor of spontaneous hemorrhagic transformation after acute ischemic stroke. Combined with period between stroke onset and admission, score of NIHSS, and history of cerebral hemorrhage, history of atrial fibrillation could predict the incidence of spontaneous hemorrhagic transformation.