Baseline brain imaging signs in patients with ischaemic stroke by the presence of atrial fibrillation: the ENCHANTED trial

Xia Wang; Shoujiang You; Zien Zhou; Candice Delcourt; Joanna Wardlaw; Grant Mair; Thompson Robinson; Xiaoying Chen; Sohei Yoshimura; Takako Torii-Yoshimura; Cheryl Carcel; Alejandra Malavera; Craig Anderson; Richard I Lindley

doi:10.1007/s00415-023-11580-x

Baseline brain imaging signs in patients with ischaemic stroke by the presence of atrial fibrillation: the ENCHANTED trial

Xia Wang, Shoujiang You, Zien Zhou, Candice Delcourt, Joanna Wardlaw, Grant Mair, Thompson Robinson, Xiaoying Chen, Sohei Yoshimura, Takako Torii-Yoshimura, Cheryl Carcel, Alejandra Malavera, Craig Anderson, Richard I Lindley

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Abstract

BACKGROUND: We aimed to assess the association of atrial fibrillation (AF) on outcomes in a post hoc analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) and how this association is modified by baseline imaging features.

METHODS: Inverse probability of treatment weight was used to remove baseline imbalances between those with and without AF. The primary outcome was the modified Rankin Scale (mRS) scores at 90 days. Secondary outcomes were symptomatic intracerebral haemorrhage (sICH), early neurological deterioration or death within 24 h, and death at 90 days. The logistic regression model was used to determine the associations.

RESULTS: Of the 3285 patients included in this analysis, 636 (19%) had AF at baseline. Compared with non-AF, AF was not significantly associated with an unfavourable shift of mRS (odds ratio 1.09; 95% confidence interval, 0.96-1.24), but with sICH (2.82; 1.78-4.48; IST-3 criteria), early neurological deterioration or death within 24 h (1.31; 1.01-1.70), and death (1.42; 1.12-1.79). Among patients with acute ischaemic signs (presence, extent, swelling and attenuation of acute lesions), AF was associated with the increased risk of all the poor outcomes (all P < 0.04 for interaction).

CONCLUSIONS: We found AF increased risk of sICH, early neurological deterioration or death and death, but not unfavourable functional recovery at day 90 after thrombolysis in patients with AIS. The presence of acute ischaemic brain imaging signs at stroke presentation could be used to improve risk stratification in the presence of AF.

TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (NCT01422616).

Original language	English
Journal	Journal of Neurology
Early online date	20 Mar 2023
DOIs	https://doi.org/10.1007/s00415-023-11580-x
Publication status	E-pub ahead of print - 20 Mar 2023

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Wang, X., You, S., Zhou, Z., Delcourt, C., Wardlaw, J., Mair, G., Robinson, T., Chen, X., Yoshimura, S., Torii-Yoshimura, T., Carcel, C., Malavera, A., Anderson, C., & Lindley, R. I. (2023). Baseline brain imaging signs in patients with ischaemic stroke by the presence of atrial fibrillation: the ENCHANTED trial. Journal of Neurology. Advance online publication. https://doi.org/10.1007/s00415-023-11580-x

@article{8490170c968945e69c91dba821b55fb6,

title = "Baseline brain imaging signs in patients with ischaemic stroke by the presence of atrial fibrillation: the ENCHANTED trial",

abstract = "BACKGROUND: We aimed to assess the association of atrial fibrillation (AF) on outcomes in a post hoc analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) and how this association is modified by baseline imaging features.METHODS: Inverse probability of treatment weight was used to remove baseline imbalances between those with and without AF. The primary outcome was the modified Rankin Scale (mRS) scores at 90 days. Secondary outcomes were symptomatic intracerebral haemorrhage (sICH), early neurological deterioration or death within 24 h, and death at 90 days. The logistic regression model was used to determine the associations.RESULTS: Of the 3285 patients included in this analysis, 636 (19%) had AF at baseline. Compared with non-AF, AF was not significantly associated with an unfavourable shift of mRS (odds ratio 1.09; 95% confidence interval, 0.96-1.24), but with sICH (2.82; 1.78-4.48; IST-3 criteria), early neurological deterioration or death within 24 h (1.31; 1.01-1.70), and death (1.42; 1.12-1.79). Among patients with acute ischaemic signs (presence, extent, swelling and attenuation of acute lesions), AF was associated with the increased risk of all the poor outcomes (all P < 0.04 for interaction).CONCLUSIONS: We found AF increased risk of sICH, early neurological deterioration or death and death, but not unfavourable functional recovery at day 90 after thrombolysis in patients with AIS. The presence of acute ischaemic brain imaging signs at stroke presentation could be used to improve risk stratification in the presence of AF.TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (NCT01422616).",

author = "Xia Wang and Shoujiang You and Zien Zhou and Candice Delcourt and Joanna Wardlaw and Grant Mair and Thompson Robinson and Xiaoying Chen and Sohei Yoshimura and Takako Torii-Yoshimura and Cheryl Carcel and Alejandra Malavera and Craig Anderson and Lindley, {Richard I}",

note = "{\textcopyright} 2023. The Author(s).",

year = "2023",

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day = "20",

doi = "10.1007/s00415-023-11580-x",

language = "English",

journal = "Journal of Neurology",

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TY - JOUR

T1 - Baseline brain imaging signs in patients with ischaemic stroke by the presence of atrial fibrillation

T2 - the ENCHANTED trial

AU - Wang, Xia

AU - You, Shoujiang

AU - Zhou, Zien

AU - Delcourt, Candice

AU - Wardlaw, Joanna

AU - Mair, Grant

AU - Robinson, Thompson

AU - Chen, Xiaoying

AU - Yoshimura, Sohei

AU - Torii-Yoshimura, Takako

AU - Carcel, Cheryl

AU - Malavera, Alejandra

AU - Anderson, Craig

AU - Lindley, Richard I

PY - 2023/3/20

Y1 - 2023/3/20

N2 - BACKGROUND: We aimed to assess the association of atrial fibrillation (AF) on outcomes in a post hoc analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) and how this association is modified by baseline imaging features.METHODS: Inverse probability of treatment weight was used to remove baseline imbalances between those with and without AF. The primary outcome was the modified Rankin Scale (mRS) scores at 90 days. Secondary outcomes were symptomatic intracerebral haemorrhage (sICH), early neurological deterioration or death within 24 h, and death at 90 days. The logistic regression model was used to determine the associations.RESULTS: Of the 3285 patients included in this analysis, 636 (19%) had AF at baseline. Compared with non-AF, AF was not significantly associated with an unfavourable shift of mRS (odds ratio 1.09; 95% confidence interval, 0.96-1.24), but with sICH (2.82; 1.78-4.48; IST-3 criteria), early neurological deterioration or death within 24 h (1.31; 1.01-1.70), and death (1.42; 1.12-1.79). Among patients with acute ischaemic signs (presence, extent, swelling and attenuation of acute lesions), AF was associated with the increased risk of all the poor outcomes (all P < 0.04 for interaction).CONCLUSIONS: We found AF increased risk of sICH, early neurological deterioration or death and death, but not unfavourable functional recovery at day 90 after thrombolysis in patients with AIS. The presence of acute ischaemic brain imaging signs at stroke presentation could be used to improve risk stratification in the presence of AF.TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (NCT01422616).

AB - BACKGROUND: We aimed to assess the association of atrial fibrillation (AF) on outcomes in a post hoc analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) and how this association is modified by baseline imaging features.METHODS: Inverse probability of treatment weight was used to remove baseline imbalances between those with and without AF. The primary outcome was the modified Rankin Scale (mRS) scores at 90 days. Secondary outcomes were symptomatic intracerebral haemorrhage (sICH), early neurological deterioration or death within 24 h, and death at 90 days. The logistic regression model was used to determine the associations.RESULTS: Of the 3285 patients included in this analysis, 636 (19%) had AF at baseline. Compared with non-AF, AF was not significantly associated with an unfavourable shift of mRS (odds ratio 1.09; 95% confidence interval, 0.96-1.24), but with sICH (2.82; 1.78-4.48; IST-3 criteria), early neurological deterioration or death within 24 h (1.31; 1.01-1.70), and death (1.42; 1.12-1.79). Among patients with acute ischaemic signs (presence, extent, swelling and attenuation of acute lesions), AF was associated with the increased risk of all the poor outcomes (all P < 0.04 for interaction).CONCLUSIONS: We found AF increased risk of sICH, early neurological deterioration or death and death, but not unfavourable functional recovery at day 90 after thrombolysis in patients with AIS. The presence of acute ischaemic brain imaging signs at stroke presentation could be used to improve risk stratification in the presence of AF.TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (NCT01422616).

U2 - 10.1007/s00415-023-11580-x

DO - 10.1007/s00415-023-11580-x

M3 - Article

C2 - 36939933

SN - 0340-5354

JO - Journal of Neurology

JF - Journal of Neurology

ER -

Baseline brain imaging signs in patients with ischaemic stroke by the presence of atrial fibrillation: the ENCHANTED trial

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