J Neurocrit Care.  2022 Dec;15(2):88-95. 10.18700/jnc.220063.

In-hospital mortality of atrial fibrillation-associated acute ischemic stroke in the intensive care unit

• Kim DY
• Kang J
• Jeong HG
• Park CY
• Kim JY
• Kim BJ
• Han MK
• Bae HJ
• Kim BK
• on behalf of Clinical Research Collaboration for Stroke in Korea (CRCS-K) Investigators

• KMID: 2538765
• DOI: http://doi.org/10.18700/jnc.220063

Abstract

Background
Although atrial fibrillation (AF)-associated acute ischemic stroke (AIS) is on the rise, is devastating, and life-threatening, there is limited data on the clinical course and in-hospital mortality of patients treated in the intensive care unit (ICU). This study aimed to describe the clinical course and factors associated with in-hospital mortality in AF-associated AIS patients admitted to the ICU.
Methods
This study was a retrospective analysis of a prospective nationwide multicenter cohort including non-valvular AF-AIS patients receiving ICU care admitted to 14 stroke centers in South Korea from 2017 to 2020. In-hospital outcomes, including in-hospital mortality and neurological deterioration (ND) have been described. Result: Amongst 2,487 AF-associated AIS patients, 259 (10.4%) were treated in the ICU. In-hospital mortality and ND occurred in 8.5% and 17.0% of the patients, respectively. Higher rates of initial National Institute for Health Stroke Scale scores, symptomatic steno-occlusive lesions, and CHA₂DS₂-VASc (Congestive Heart Failure, Hypertension, Age ≥75 [Doubled], Diabetes Mellitus, Prior Stroke or Transient Ischemic Attack [Doubled], Vascular Disease, Age 65–74, Female) scores were found in those with in-hospital mortality. The CHA₂DS₂-VASc score after admission increased the risk of in-hospital mortality (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.00–2.18) were associated with in-hospital mortality. Antithrombotic use within 48 hours was related to decreased in-hospital mortality (OR, 0.26; 95% CI, 0.10–0.67).
Conclusion
ICU care in AF-associated AIS is common, and the establishment of optimal treatment strategies in the ICU may be needed.

Keyword

Stroke; Atrial fibrillation; Cerebral infarction; Critical care; Intensive care units

Figure

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  Fig. 1. Study population. ICU, intensive care unit.

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