Introduction: In acute stroke patient, overall outcome with the patient with cardioembolism is poor because of recurrence and complications related with anticoagulation. However, if patients is indicated for acute thrombectomy, the outcome could be different based on the clot nature. We aimed to determine in-hospital outcome for the acute stroke patients with atrial fibrillation (Afib) and /or flutter which are the most common causes of cardioembolic stroke.
Methods: We utilized the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (2006 to 2013; 58,805,848 patients). We included 5,429 adult acute stroke patients who underwent endovascular thrombectomy using ICD-9 diagnosis and procedure code. We analyzed outcome of the patient with Afib and/or atrial flutter or not.
Applying logistic regression analyses (SAS 9.4; SPSS 22) and adjusting for (1) comorbidities; hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, congestive heart failure, tobacco/alcohol dependence and morbid obesity, (2)Socio-economic status; age, sex and races, (3) care complexity; number of comorbidities, numbers of inpatient diagnosis/ procedures. We compared in-hospital outcome including mortality, discharge disposition (long term facility or not), length of hospital stay and hospital cost.
Results: Mean age of endovascular thrombectomy patients with acute stroke was 66.1 years (SD ±15.4 years) with 45% >65 years old; 48.9% females; 72.7% Whites. As an outcome makers, in-patient mortality 20.2%, discharge disposition to long term facility 70.8%, mean hospital length of stay 10.2 days (SD ±10.2) and mean hospital costs $177,606 (SD ± $145,202). 62.3% of patient had Afib or flutter. After covariate adjustment, the patients with Afib or flutter had a better outcome in discharge disposition (P<0.001, Cox-Snell R2=0.172, Binary multiple logistic regression); Long term facility 67.9% with Afib or flutter Vs. 75.5% without Afib or flutter.
Conclusions: The RBC rich clot related with Afib is relatively easy to retrieve with endovascular procedure resulting better functional outcome.
Patient Care: Patient's functional outcome can be predicted with on clot nature after endovascular thrombectomy.
Learning Objectives: Clot nature considering stroke etiology is important for the patient functional outcome in endovascular thrombectomy.