Atrial fibrillation/flutter at presentation is associated with worse functional outcome in acute ischemic stroke patients treated with thrombolytic therapy: A multicenter retrospective cohort study.

BACKGROUND

Electrocardiographic (EKG) abnormalities are frequently observed in patients with acute ischemic stroke (AIS), yet their prognostic significance in patients treated with intravenous thrombolysis remains incompletely understood. While brain-heart interactions have been well described in intracerebral hemorrhage, fewer data exist regarding the impact of EKG abnormalities on functional outcomes after AIS.

METHODS

We conducted a multicenter retrospective cohort study of consecutive AIS patients treated with intravenous thrombolytic therapy at Southern Illinois Healthcare (2017-2024) and the University of Oklahoma Health Sciences Center (2022-2024). Demographic characteristics, vascular risk factors, baseline modified Rankin Scale (mRS), stroke severity (NIHSS), treatment metrics, and EKG findings on admission were collected. Multivariable logistic regression models were constructed to evaluate the association between EKG abnormalities and in-hospital mortality, favorable functional outcome (mRS 0-2 at 30 days), and severe disability or death (mRS 5-6 at 30 days), adjusting for age, sex, vascular risk factors, baseline mRS, stroke severity, and thrombectomy. Statistical significance was set at p < 0.05.

RESULTS

Among 473 thrombolysis-treated AIS patients, 307 (65%) demonstrated at least one EKG abnormality on admission. The most common abnormality was QTc prolongation (61%), followed by ectopic beats (26%), and atrial fibrillation/flutter (16%). Patients with EKG abnormalities were older, had higher baseline NIHSS scores, and more frequently had preexisting cardiac history (p < 0.05 for all). In adjusted analyses, atrial fibrillation/flutter on admission was independently associated with increased odds of in-hospital mortality (OR:2.37 95% CI: 1.13-5.59, p = 0.034) and reduced likelihood of favorable functional outcome (OR: 0.47 95%CI: 0.23-0.96, p = 0.038). No other EKG abnormality retained independent prognostic value after multivariable adjustment.

CONCLUSIONS

In AIS patients treated with thrombolytic therapy, admission EKG abnormalities are common and reflect a higher burden of systemic and neurological disease. Atrial fibrillation/flutter independently predicts worse functional outcomes and higher mortality, emphasizing its role as a poor prognostic marker in AIS.