222 - Mechanical Thrombectomy in Atrial Fibrillation–Associated Acute Ischemic Stroke: National Trends and Outcomes

Purpose: Patients presenting with acute ischemic stroke (AIS) with concurrent history of atrial fibrillation may require additional safety measures with management. AF-associated AIS has been demonstrated to have poorer functional outcomes than non-AF when treated with IVT or medical management. Recent smaller registry data has been shown that MT among patients with AF is non-inferior in outcomes compared to patients with non-AF. Herein, we analyze the trends in proportion and outcomes of AF-associated AIS among patients receiving MT using a nationally-represented hospitalization database.

Materials and Methods: The National Inpatient Sample (NIS) was queried between January 1, 2013, and December 31, 2020, for patients undergoing MT for AIS. Patients with AF were compared to non-AF patients regarding inpatient mortality, discharge other than home (DOTH), and 90-day poor functional outcome (akin to modified Rankin Scale >3, methodology explained by Patel et al.). Negative binomial regression was conducted to assess factors associated with length of stay in days (LOS). Cochran-Armitage test was conducted to assess the linear trend of proportion of AF among patients receiving MT for AIS. All estimates were nationalized using discharge weights provided by HCUP.

Results: A total of 158,850 admissions involving MT for AIS were identified. Of these, 70,055 (44.1%) were associated with AF. The average age was higher among AF compared to non-AF (75.4 [15] vs. 63.3 [11]; p< 0.001). The proportion of females was higher among AF (40,620 [46%] vs. 39,375 (56%); p< 0.001). The proportion of utilization of tPA was similar among the two groups (21,760 [25%] vs. 16,775 [24%]; p=25). There was an increase in trend in proportion of AF among those who received MT for AIS (Trend: -0.64%; p< 0.001). Compared to non-AF patients, those with AF had lower odds of mortality (OR: 0.72; p< 0.001) and DOTH (OR: 0.81; p< 0.001). There were similar odds of 90-day poor functional outcome between the two groups (OR: 0.95; p=0.38). AF was associated with decreased LOS by 9.2% (p< 0.001).

Conclusion: In admissions involving MT for AIS, AF was associated with lower odds of in-hospital mortality, DOTH, and LOS. There were similar odds of 90-day poor functional outcome among the two groups. This analysis was in contrast to previous literature demonstrating poorer outcomes for patients with AF-associated AIS compared to non-AF patients. This may indicate that MT is safe for patients presenting with AIS and AF.