Abstract WP147: Impact Of Heart Failure With Reduced Ejection Fraction On Procedural And Functional Outcomes In Patients With Large Vessel Occlusion Stroke Undergoing Mechanical Thrombectomy.

Abstract

Introduction: Heart failure with reduced Ejection Fraction (HFrEF) is an important risk factor for ischemic stroke and has been shown to carry higher mortality among stroke survivors. However, data among patients with large vessel occlusion strokes (LVOS) undergoing mechanical thrombectomy (MT) is lacking. We aimed to investigate the impact of HFrEF on procedural and functional outcomes after MT. Methods: We conducted a retrospective analysis of a prospectively collected MT database of all consecutive anterior circulation LVOS (Intracranial ICA, MCA-M1, M2) patients undergoing MT at a large urban comprehensive stroke center from Jan,2015-Dec,2020. HFrEF was defined as LVEF ≤40% on transthoracic or transesophageal echocardiograms obtained during the same admission. Uni-multivariable analyses were performed to evaluate the predictors of first pass effect (FPE), mRS0-2 and mortality at 90 days. Results: Of 1466 patients included in the analysis, 293 had HFrEF. The HFrEF group had fewer females, higher median baseline NIHSS, higher rates of Atrial fibrillation (p<0.001), shorter median procedural duration (33 vs 37 min,p=0.006), higher frequency of FPE (47.1% vs 40.4%,p=0.038), higher 90-day mortality (26.9% vs 18.5%,p=0.005) and lower rate of 90-day mRS0-2 (41.4% vs 49.3%,p=0.03). On multivariable analyses, CHF was a predictor of FPE (OR1.33,95%CI[1.021-1.733],p=0.035), but not a predictor of mRS0-2 (OR0.784,95%CI[0.52-1.184],p=0.25) or mortality (OR1.443,95%CI [0.92-2.265],p=0.11) at 90 days.(Fig) Conclusion: Our single-center study showed that HFrEF was associated with better procedural outcomes but did not impact functional outcomes at 90-day. Large multi-center studies are warranted.