Outcomes of patients with heart failure after thrombectomy for ischemic stroke: A systematic review and meta-analysis

Abstract

Background

Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke, but its outcomes in patients with heart failure (HF) are uncertain. Some studies suggest worse outcomes in these patients, while others show no significant differences in mortality or functional recovery.

Methods

We systematically searched the MEDLINE, Embase, and Cochrane databases until August 2024. Studies were included if they compared patients with HF to those without. All statistical analyses were carried out using R, version 4.1.1. A subanalysis examined outcomes in HF patients with reduced left ventricular ejection fraction (LVEF).

Results

We included 3587 patients, of which 1187 (33.1%) were in the HF group. We found a significantly higher mortality (RR 2.01; 95% CI: 1.33–3.03; p < 0.01) and lower risk of favorable neurologic outcome (RR 0.76; 95% CI: 0.67–0.86; p < 0.01) at 90 days on HF group, without a notable difference in the occurrence of symptomatic intracranial hemorrhage (sICH) (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). HF patients with reduced LVEF also showed 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) compared to those without HF.

Conclusions

HF patients undergoing MT for ischemic stroke may have worse functional outcomes and higher mortality at 90 days compared to non-HF patients despite similar rates of sICH and recanalization success. Our findings suggest that patients with HF may have a worse prognosis compared to those without HF following MT for ischemic stroke.