C-Reactive Protein elevation and subsequent atrial fibrillation detection after ischemic stroke treated with mechanical thrombectomy: an inverse probability weighting analysis

Background and aims: Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke due to large vessel occlusion (LVO). Atrial fibrillation (AF) can be known before the stroke (or prevalent AF) or be newly detected after stroke (post-stroke AF). Inflammation plays a critical role in the pathogenesis of post-stroke AF making inflammatory markers valuable for early detection of post-stroke AF. This study investigated the predictive value of C-reactive protein (CRP) and other inflammatory biomarkers in predicting post-stroke AF in acute ischemic stroke patients treated with MT. Methods: This observational multicentre retrospective cohort study included 849 patients with anterior circulation LVO treated with MT across four centres from 2016 to 2023. Patients were divided into post-stroke AF and NO-AF groups, excluding those with prevalent AF. Baseline demographics, clinical and procedural variables, and inflammatory biomarkers, including CRP, were collected at admission and 24 hours post-procedure. Baseline characteristics were balanced using inverse probability weighting (IPW). Logistic regression and receiver operating characteristic (ROC) analyses assessed the predictive value of CRP for post-stroke AF. Results: The study included 849 patients with a median age of 66 years (IQR 54-76) and 477 (56.2%) were female. Post stroke AF was detected in 186 (21.9%) patients while 663 (78.1%) did not experience AF during admission. In the weighted population CRP levels, both admission and 24 hours post-procedure, were higher in post-stroke AF patients. In logistic regression analysis admission and 24-h CRP levels were associated with increased probability of post-stroke AF, respectively (OR 1.01; 95% CI 1.00-1.03, p<0.001) and (OR 1.02, 95% CI 1.01-1.03, p < 0.001) following MT. We observed that the model combining age, sex, hypertension, heart failure, alcoholism, coronary artery disease, diabetes mellitus, smoking, previous TIA and ischemic stroke and admission CRP (AUC 0.723, 95% CI 0.71-0.74) and 24h CRP (AUC 0.704, 95% CI 0.69-0.72) had good predictive accuracy, with optimal cutoff values of 4.25 for admission CRP and 14.69 for 24-h CRP to detect post-stroke AF. Subgroup analysis indicated CRP predictive relevance, particularly in hypertensive patients. Conclusions: Our findings suggest CRP is associated with post-stroke AF in stroke patients due to LVO, highlighting inflammation's role in AF pathogenesis. Measuring CRP at admission and 24 hours may enable early detection and timely anticoagulation. Incorporating CRP into clinical pathways could improve individualized risk assessment, warranting further studies to validate its predictive utility and explore additional markers.