Recurrent Stroke in Patients With Cryptogenic Stroke and Left Ventricular Injury: The Cardiac Abnormalities in Stroke Prevention and Recurrence (CASPR) Study.
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Sharma Richa, McNamara Katelyn F, Badillo Goicoechea Elena, Bowman Anna, Van Coevering Russell, Chen Lucia, Penckofer Mary, Singh Eesha, Kerrigan Deborah, Aboul-Nour Hassan, Nahab Fadi, Glover Patrick, Krishnaiah Balaji, Yaghi Shadi, Khasiyev Farid, Lineback Christina M, Melkumova Emiliya, Culbertson Collin, Nguyen Thanh N, Thompson Sean L, Jillella Dinesh, Daniel Jean-Philippe Auguste, Aziz Yasmin, Alvi Muhammad, Herpich Franziska, Shahrivari Mahan, Chionatos Rafail A, Elangovan Cheran, Kang Jieun, Zha Alicia, Farooqui Mudassir, Rothstein Aaron, Khan Farhan, Smith Matthew, Brown Samantha J, Abu Qdais Ahmad, Liebeskind David S, Abburi Nandini, Rozental Stefano, Nedelcu Simona, Thon Jesse M, Stretz Christoph, Thottempudi Neeharika, Yu Wenzheng, Eklund Kelsey, Linares Guillermo, de Havenon Adam, Siegler James E
Аннотация
METHODS: We performed a multicenter, retrospective study of Cardiac Abnormalities in Stroke Prevention and Recurrence cohort across 27 US sites. Patients with LV ejection fraction ≥20% were included. LV injury, defined as LV ejection fraction 20% to 40% and wall motion abnormality, was the primary exposure and treatment effect modifier. The treatment of interest was anticoagulant versus antiplatelet therapy. The composite outcome included recurrent stroke, major bleeding, or death. Outcomes were evaluated using unadjusted and inverse probability weighting adjusted Cox proportional hazards models, with treatment effect modification tested by LV injury status.
RESULTS: Among 2685 patients enrolled, 2328 with complete data were analyzed (median age, 65 years; 49.8% female; median follow-up, 1.6 years). LV injury was present in 310 patients (13.3%). Overall, 535 events occurred: 258 recurrent ischemic strokes, 28 hemorrhagic strokes, 67 major hemorrhages, and 256 deaths. LV injury was associated with a higher unadjusted risk of the primary outcome (hazard ratio [HR], 1.51 [95% CI, 1.21-1.87]), though nonsignificant after inverse probability weighting adjustment (adjusted HR, 1.29 [95% CI, 0.97-1.70]). In the LV injury subgroup, anticoagulation versus antiplatelet therapy was associated with a lower risk of the primary outcome (adjusted HR, 0.24 [95% CI, 0.10-0.59]), relative to the non-LV injury subgroup (adjusted HR, 1.28 [95% CI, 0.83-1.95]; p[LV-interaction], 0.001). Similar interactions were seen for EF 20% to 40% (versus >40%; adjusted HR, 0.19 [95% CI, 0.04-0.86]; p[LV-interaction], 0.001) and wall motion abnormality (versus no wall motion abnormality; adjusted HR, 0.33 [95% CI, 0.15-0.73]).
CONCLUSIONS: After cryptogenic stroke, anticoagulation in those with LV injury was associated with lower rates of recurrent stroke, major bleeding, and death. These findings warrant confirmation in a dedicated randomized controlled trial.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06398366.