ABSTRACT NUMBER: ESOC2026A1022 THE IMPACT OF CARDIAC THROMBI ON OUTCOME AFTER REPERFUSION THERAPIES IN ACUTE ISCHAEMIC STROKE

Abstract Background and aims Cardiac thrombi detected on CT in acute ischaemic stroke (AIS) can provide important prognostic information. We determined the association between cardiac thrombi and outcomes following reperfusion therapies in AIS. Methods This was a sub-analysis of international multicentre AIS of HEARTS collaboration which included AIS patients receiving reperfusion therapy at the study centres between 2018 and 2024. We evaluated the association between cardiac thrombi and 90-day clinical outcomes. Results Reperfusion therapy was administered to 1804 patients: 863 (47.8%) with IV thrombolysis only, 594 (32.9%) with EVT only, and 347 (19.2%) were treated with both IVT and EVT. Functional independence (mRS 0-2) was achieved in 987 (54.7%) patients. Patients achieving independent outcome were younger (median age 70 vs 79, p<0.001), had a lower baseline NIHSS (6 vs 13, p<0.001), with less known AF (17.6% vs 30.7%, p<0.001), less large vessel occlusion (45.8% vs 60.4%, p<0.001), and less cardiac thrombi on CT (4.1% vs 8.9%, p<0.001). The presence of cardiac thrombi was associated with reduced chance of functional independence (OR 0.624, 95% CI 0.385–1.012; p=0.056) after adjusting for age, sex, pre-morbid mRS, baseline NIHSS and LVO. All-cause 90-day mortality was 15.2%, with a trend towards increased mortality in patients with cardiac thrombi (OR 1.555, 95% CI 0.940-2.572; p=0.086). Conclusions Cardiac thrombus was associated with worse functional outcome and increased mortality among patients receiving reperfusion therapies for AIS. Conflict of interest Shuyu Guo: nothing to disclose. Shan Sui Nio: nothing to disclose. Md Golam Hasnain: nothing to disclose. Daniel S. Green: Nil conflicts of interest. This research was supported by the Australian Government Research Training Program Scholarship. Alexander Berry-Noronha: nothing to disclose. John Fink: nothing to disclose. Mark Parsons: nothing to disclose. Carlos Garcia-Esperon: nothing to disclose. Teddy Wu: nothing to disclose. Jonathan Coutinho: nothing to disclose.