Abstract
Background
Heart failure (HF) is the second most important cardiac risk factor for stroke after atrial fibrillation (AF). Few data are available on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with HF.
Methods
The source of data is the multicentre Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). All AIS patients ≥ 18 years receiving MT were categorised in two groups: HF and no-HF. Baseline clinical and neuroradiological findings on admission were analysed.
Results
Of 8924 patients, 642 (7.2%) had HF. Compared to the no-HF group, HF patients had higher prevalence of cardiovascular risk factors. Rate of complete recanalisation (TICI 2b-3) was 76.9% in HF vs 78.1% in no-HF group (p = 0.481). Rate of symptomatic intracerebral haemorrhage at 24-h non-contrast computed tomography (NCCT) was 7.6% in HF vs 8.3% in no-HF patients (p = 0.520). At 3 months, 36.4% of HF patients and 48.2% of no-HF patients (p < 0.001) had mRS 0–2, and mortality was, respectively, 30.7% and 18.5% (p < 0.001). In multivariate logistic regression, HF was independently associated with mortality at 3 months (OR 1.53, 1.24–1.88 95% CI, p < 0.001). In multivariate ordinal regression, HF patients had a probability of transitioning to a higher mRS level of 1.23 (1.05–1.44 95% CI, p = 0.012). The propensity score analysis of two groups matched for age, sex, and NIHSS at admission yielded the same results.
Conclusion
MT is safe and effective in HF patients with AIS. Patients with HF and AIS suffered from higher 3-month mortality and unfavourable outcome regardless of acute treatments.
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Data Availability
Anonymized data will be shared by request from any qualified investigator.
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The authors declare the following competing interests with respect to the research, authorship, and/or publication of this article: Andrea Zini: consultant for Alexion, Boehringer Ingelheim and CSL Behring. Simona Sacco: personal fees and non-financial support from Abbott, Allergan-Abbvie, AstraZeneca, Eli Lilly, Lundbeck, Novartis, NovoNordisk, Pfizer, Teva, Medscape, Neurodiem Ology Medical Education, Allergan, Novartis, Uriach; Marco Petruzzellis: advisory board Andexanet Alexion Pharma. Mauro Bergui: consultation fees from Stryker, Penumbra. Danilo Toni: Advisory Board and speaker’s honoraria from Abbott; Alexion; Bayer; Biogen; BMS; Boehringer Ingelheim; Daiichi Sankyo; Medtronic; Pfizer.
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Gentile, L., Pracucci, G., Saia, V. et al. Mechanical thrombectomy in patients with heart failure: the Italian registry of Endovascular Treatment in Acute Stroke. Neurol Sci 44, 3577–3585 (2023). https://doi.org/10.1007/s10072-023-06830-9
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DOI: https://doi.org/10.1007/s10072-023-06830-9