Cardiac Events After Mechanical Thrombectomy in Acute Ischemic Stroke: A Nation-Wide Cohort Study

Introduction

Mechanical thrombectomy (MT) markedly improves the outcome in patients with large vessel occlusion stroke. Given the cardiovascular risk profile of these patients, we wanted to investigate their post-MT risk of cardiac events compared to other patients with acute ischemic stroke (AIS).

Methods

All hospitalizations for AIS in Denmark from 2014 to 2021 were included in this registry-based cohort study. Patients were categorized by reperfusion treatment: MT with or without intravenous thrombolysis (IVT), IVT alone, or no reperfusion treatment (NRT). Cardiac events included ischemic heart disease, heart failure, or cardiac death within 6 months of AIS. Pair-wise group comparisons were performed after inverse probability treatment weighting (IPTW).

Results

Among 76,092 AIS patients, 4.4% received MT, 15.2% received IVT alone, and 80.4% received NRT. In the MT group, 9.6% of patients experienced cardiac events. After IPTW, MT patients had the highest risk of cardiac events compared to IVT (absolute risk difference [ARD] 4.6%, cause-specific hazard rate ratio [HRR] 1.42 [95% CI: 1.27–1.60]) and NRT (ARD 4.6%, HRR 1.35 [95% CI: 1.22–1.49]). Pre-existing cardiac disease was similar across groups (9.2%–11.8%) and after exclusion of patients with prior cardiac disease, the HRR of cardiac events remained consistent with the primary analysis (MT vs. IVT: HRR 1.48 [95% CI: 1.31–1.68]; MT vs. NRT: 1.39 [95% CI: 1.24–155]).

Conclusion

10% of patients with AIS undergoing MT experienced cardiac events within 6 months compared to 5% of other AIS patients. This study identified an unrecognized burden of cardiac disease in this group of AIS patients treated with MT.