Albumin levels and risk of early cardiovascular complications after endovascular thrombectomy for acute ischaemic stroke

We evaluate the clinical course of patients with hypoalbuminemia who underwent endovascular thrombectomy (EVT) within 24 h of acute ischaemic stroke (AIS). A retrospective cohort study using data from the global federated research network TriNetX. Adults ≥ 18 years treated with EVT for AIS between 2018 and 2024 with serum albumin measured within 24 h post-EVT were included. Patients were grouped by serum albumin levels: reduced (≤ 3.4 g/dL) vs. normal (≥ 3.5 g/dL). The primary outcome was a 30-day composite of all-cause death, acute heart failure, atrial fibrillation, ventricular arrhythmias, acute myocardial infarction, Takotsubo syndrome. Secondary outcomes included individual components and intracranial haemorrhage. Propensity score matching (1:1) balanced covariates, followed by Cox regression to estimate hazard ratios (HRs) and 95% confidence interval (CI)s. Among 8,698 patients with AIS treated with EVT, 6,233 had normal serum albumin (mean age 67.0 ± 14.5 years, 44.0% female), while 2,465 had reduced albumin (69.7 ± 14.3 years, 51.5% female). After matching, 2,374 patients with reduced albumin had higher risk of the composite outcome (HR 1.28, 95%CI 1.17-1.39), all-cause mortality (HR 1.72, 95%CI 1.50-1.96), and acute myocardial infarction (HR 1.74, 95%CI 1.28-2.35), compared to those with normal albumin. These associations remained consistent across subgroups stratified by age, sex, stroke severity, causes of hypoalbuminemia, degrees of hypoalbuminemia reduction. Hypoalbuminemia in patients with AIS treated with EVT is associated with an increased risk of early cardiovascular events. Serum albumin may be a prognostic biomarker in this population.