The impact of selected cardiovascular factors on the safety and efficacy of intravenous thrombolysis for acute ischemic stroke in routine practice in a rural hospital

Introduction
Cardiac and electrocardiography (ECG) abnormalities are common in acute ischemic stroke (AIS) patients.

Aim of the research
To evaluate the relationship between selected cardiovascular factors and the long-term outcome, the presence of hemorrhagic transformation (HT), symptomatic intracerebral hemorrhage (SICH) and mortality in Caucasian patients with AIS treated with intravenous thrombolysis (i.v. thrombolysis) in routine practice.

Material and methods
We prospectively evaluated 286 stroke patients in terms of the impact of cardiovascular factors and changes in the transthoracic echocardiogram (TTE) on the safety and effectiveness of intravenous (i.v.) thrombolysis.

Results
In the analyzed group we found atrial fibrillation (AF) in 35.3% of patients and cardiogenic stroke in 31.5% of patients. The first abnormal ECG (p = 0.02) and the presence of AF (p = 0.002) were higher in patients with an unfavorable outcome (modified Rankin Scale, 3–6 points) and in patients who died within 3 months’ follow-up (p = 0.02, p = 0.004 respectively). Only median NIHSS score at the time of admission was associated with cardiogenic stroke (p = 0.01). There was no impact of TTE findings on safety and efficacy of i.v. thrombolysis. No significant differences in the long-term outcome, HT and SICH rates and mortality between the subgroups of patients with cardiogenic stroke and patients with other types of strokes were observed. Multivariate analysis showed the impact of AF on the long-term unfavorable outcome (p = 0.02) and mortality rate (p = 0.04).

Conclusions
Atrial fibrillation is a strong predictor of unfavorable long-term outcome and death in patients with AIS treated with i.v. thrombolysis in routine practice. Further studies assessing cardiac function in patients undergoing i.v. thrombolysis are needed.