Outcomes of patients with heart failure after thrombectomy for ischemic stroke: A systematic review and meta-analysis.
Gabriel Marinheiro, Gabriel de Almeida Monteiro, Ivo Queiroz et al.
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In 30 seconds
This systematic review and meta-analysis compared outcomes after mechanical thrombectomy (MT) for acute ischemic stroke in patients with and without heart failure (HF). Across 3587 patients, including 1187 with HF, HF was associated with higher 90-day mortality (RR 2.01; 95% CI: 1.33-3.03; p < 0.01) and a lower likelihood of favorable neurologic outcome (RR 0.76; 95% CI: 0.67-0.86; p < 0.01). Symptomatic intracranial hemorrhage and recanalization success did not differ notably. Findings in the reduced-LVEF subgroup were directionally similar.
Key findings
- HF was associated with higher 90-day mortality after MT (RR 2.01; 95% CI: 1.33-3.03; p < 0.01).
- Favorable neurologic outcome at 90 days was less likely in patients with HF (RR 0.76; 95% CI: 0.67-0.86; p < 0.01).
- There was no notable difference in symptomatic intracranial hemorrhage (RR 1.57; 95% CI: 0.98-2.51; p = 0.06) or recanalization success (RR 1.02; 95% CI: 0.98-1.07; p = 0.28).
- Among patients with reduced LVEF, HF was associated with higher mortality (RR 1.91; 95% CI: 1.05-3.49; p = 0.03) and worse functional outcomes (RR 0.83; 95% CI: 0.72-0.95; p < 0.01).
Why it matters
The findings indicate that HF identifies a group with poorer prognosis after thrombectomy, even though procedural recanalization and symptomatic bleeding were not notably different. This distinction may help frame outcome expectations and underscores the importance of considering cardiac comorbidity when interpreting post-stroke recovery. The pooled associations do not establish that HF itself causes the poorer outcomes.
What to keep in mind
The abstract does not report the number or design of included studies, and the pooled comparisons are observational; residual differences between patients with and without HF may contribute to the associations.