ABSTRACT NUMBER: ESOC2026A865 RISK OF CARDIAC OUTCOMES FOLLOWING EMBOLIC STROKE OF UNDETERMINED SOURCE (ESUS) AND CRYPTOGENIC STROKE/TIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and aims The risk of new-onset cardiac outcomes following embolic stroke of undetermined source (ESUS) and cryptogenic stroke (including TIA) is unclear. We aimed to evaluate long-term risks of new-onset cardiac outcomes and recurrent stroke following ESUS or cryptogenic stroke. Methods We searched MEDLINE and Embase on 18Mar2025, including study cohorts from RCTs, cohort studies, and cross-sectional studies reporting new-onset cardiac outcomes and/or recurrent stroke following ESUS or cryptogenic stroke with at least one-year follow-up. We completed meta-analyses of cumulative incidences, incidence rates and hazard estimates grouped by index stroke (ESUS or cryptogenic stroke). Our primary outcome was cumulative incidence of major adverse cardiovascular events (MACE). Meta-analyses were completed overall and grouped by post-stroke secondary prevention strategy (conservative/mixed medical management, anticoagulation, or PFO closure). Results Our analysis included 62 ESUS and 203 cryptogenic stroke study cohorts (22,197 and 61,957 participants, respectively). Overall, the cumulative incidence of MACE was 12% (95%CI:9-17%; n=10,282) following ESUS and 13% (95%CI:10-17%; n=11,605) after cryptogenic stroke. The overall cumulative incidence of recurrent stroke was 10% (95%CI:8-11%; n=16,961) following ESUS and 7% (95%CI:6-8%; n=32,387) after cryptogenic stroke. In participants with implantable cardiac monitors (ICMs), the overall cumulative incidence of newly detected atrial fibrillation was 27% (95%CI:23-32%; n=3,338) following ESUS and 26% (95%CI:24-28%; n=11,858) after cryptogenic stroke. Conclusions One-in-eight adults with ESUS or cryptogenic stroke develop new-onset MACE, atrial fibrillation is detected in one-in-four with ICMs following their index event, while one-in-ten and one-in-fourteen, respectively, experience recurrent stroke. Conflict of interest Nathalie Launder: nothing to disclose. Chloe Mutimer: nothing to disclose. Chushuang Chen: nothing to disclose. Louise Segan: nothing to disclose. Hannah Johns: nothing to disclose. Mark Parsons: nothing to disclose. Vignan Yogendrakumar: nothing to disclose. Leonid Churilov: nothing to disclose.