Trajectory Groups of 72-Hour Heart Rate After Mechanical Thrombectomy and Outcomes

Abstract

Background and Purpose

Elevated heart rate (HR) after mechanical thrombectomy (MT) was associated with an increased risk of adverse outcomes. However, optimal HR management after MT remains unclear. This study aimed to identify patient subgroups with distinct HR trajectories after MT and explore their association with outcomes.

Methods

Acute ischemic stroke patients undergoing MT therapy were prospectively recruited from July 2020 to December 2022. Their heart rate indicators were collected every hour for 72 hours after MT procedure. Latent variable mixture modeling was used to separate subjects into five groups with distinct HR trajectories. The primary outcome was poor functional outcome (mRS score >2) at 3 months. Additional outcome was all-cause mortality (mRS score = 6) at 3 months.

Results

A total of 224 patients with large vessel occlusion were enrolled, with a mean age of 65.2+14.0 years. Eighty-seven patients had a good functional outcome, and 137 patients had a poor functional outcome. Five distinct HR trajectories were observed: low (19.2%), moderate (33.0%), rapidly stabilized HR group (20.5%), persistently high HR group (21.0%), and very high HR group (6.3%). After adjusting for potential confounders, the HR trajectory group was independently associated with poor functional outcome at 3 months (P for interaction = 0.022). The risk of having poor functional outcome was increased in the rapidly stabilized HR group (odds ratio, 3.18 [95% confidence interval, 1.10–9.19]), the persistently high HR group (odds ratio, 5.55 [95% confidence interval, 1.72–17.87]) and very high HR group (odds ratio, 18.32 [95% confidence interval, 2.20–95.52]) but not in the moderate group (odds ratio, 1.50 [95% confidence interval, 0.61–3.69]), when compared with the low HR group. No significant association was found between trajectory group and 3-month all-cause mortality.

Conclusion

HR during the first 72 hours after MT may be categorized into distinct trajectory groups, which differ in relation to poor functional outcome event risks. The findings may help to recognize potential candidates for future HR control trials.

Key words:

• ischemic stroke
• heart rate trajectory
• mechanical thrombectomy
• outcome

Data Sharing Statement

The datasets generated and/or analysed during the current study are not publicly available due to the datasets are owned by the institution only but are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

The informed consent to participate was obtained from all participants and written informed consent in accordance with the Declaration of Helsinki. This study was performed in accordance with the appropriate guidelines and regulations. The study protocols were approved by the ethics committees of Second Affiliated Hospital of Soochow University, Soochow University.

Acknowledgments

Huaishun Wang, ChiZhang and LongdongXu are co-first authors for this study. Jiaping Xu and Guodong Xiao are co-correspondence authors for this study.

We thank the study participants, their relatives, and the clinical staff for their support and contribution to this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests and the research was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest.

Additional information

Funding

This study was supported by a grant from the National Natural Science Foundation of China (grant: 82071310), Jiangsu Provincial Medical Key Discipline Project (grant: ZDXKB2016022), Suzhou Clinical Research Center of Neurological Disease (grant: Szzx201503), Discipline Construction Program of the Second Affiliated Hospital Soochow University (grant: XKTJ-XK202001).