Abstract
Background and aims: Cardiac computed tomography (CT) is increasingly used as part of acute stroke brain imaging, but heterogeneity exists with respect to imaging protocols. We compared the proportion of patients diagnosed with intra-cardiac thrombus on ECG-gated and non-ECG-gated cardiac CT.
Methods: An individual patient data meta-analysis was undertaken of data from an international observational registry (The Netherlands, New Zealand and Australia), which included patients who underwent cardiac CT as part of acute stroke imaging. Data were obtained from between May 2018 and June 2024. The primary outcome was the proportion of cases with thrombus identified on cardiac CT.
Results: There were 3906 patients included in the analysis: 1457 (37.3%) underwent ECG-gated cardiac CT and 2449 (62.7%) underwent non-ECG-gated cardiac CT. Patients who underwent ECG-gating were younger (median age 72 versus 74, P < 0.001) and had a lower baseline prevalence of AF (17.4% versus 26.7%, P < 0.001), chronic heart failure (5.6% versus 12.6%, P < 0.001), hypertension (50.0% versus 61.7%, P < 0.001), dyslipidaemia (16.4% versus 34.2%, P < 0.001) and ischaemic heart disease (18.3% versus 23.1%, P < 0.001). The pooled positivity rate for thrombus was higher in the ECG-gated group (7.8% versus 5.5% respectively, odds ratio 1.44, 95% CI 1.11—1.87, P = 0.006). After adjustment for confounders, the association remained significant (adjusted OR 2.18, 95% CI: 1.60-2.96, P < 0.001).
Conclusions: ECG-gated cardiac CT identified thrombus in a higher proportion of patients compared to those who underwent cardiac CT without ECG-gating.