Abstract
Background and aims: Cardiac thrombi detected on CT in acute ischaemic stroke (AIS) can provide important prognostic information. We determined the association between cardiac thrombi and outcomes following reperfusion therapies in AIS.
Methods: This was a sub-analysis of international multicentre AIS of HEARTS collaboration which included AIS patients receiving reperfusion therapy at the study centres between 2018 and 2024. We evaluated the association between cardiac thrombi and 90-day clinical outcomes.
Results: Reperfusion therapy was administered to 1804 patients: 863 (47.8%) with IV thrombolysis only, 594 (32.9%) with EVT only, and 347 (19.2%) were treated with both IVT and EVT. Functional independence (mRS 0-2) was achieved in 987 (54.7%) patients. Patients achieving independent outcome were younger (median age 70 vs 79, p<0.001), had a lower baseline NIHSS (6 vs 13, p<0.001), with less known AF (17.6% vs 30.7%, p<0.001), less large vessel occlusion (45.8% vs 60.4%, p<0.001), and less cardiac thrombi on CT (4.1% vs 8.9%, p<0.001). The presence of cardiac thrombi was associated with reduced chance of functional independence (OR 0.624, 95% CI 0.385–1.012; p=0.056) after adjusting for age, sex, pre-morbid mRS, baseline NIHSS and LVO. All-cause 90-day mortality was 15.2%, with a trend towards increased mortality in patients with cardiac thrombi (OR 1.555, 95% CI 0.940-2.572; p=0.086).
Conclusions: Cardiac thrombus was associated with worse functional outcome and increased mortality among patients receiving reperfusion therapies for AIS.