Abstract TP124: Clinical Differences Between Patients Presenting With Cardioembolic Versus Large Artery Stroke

Background: Cardioembolic (CES) and large artery (LAS) strokes are common ischemic stroke subtypes. CES arises from intracardiac thrombus secondary to atrial fibrillation (AF) or structural heart disease, whereas LAS results from atherosclerosis-related stenosis and thrombosis within the cerebral circulation. It is important to distinguish patients at risk for CES vs. LAS as prevention strategies differ, e.g., anticoagulation for CES vs. atherosclerosis risk-factor management for LAS. We aimed to identify demographic, clinical, laboratory and echocardiographic predictors distinguishing CES from LAS. Methods: We included ≥18-year-old patients who presented to our center with a neurologist-classified diagnosis of CES or LAS in calendar year 2021. Demographic variables, clinical history, laboratory measurements and echocardiographic data were extracted from retrospective chart review. Differences in characteristics were assessed using Fischer exact test or independent sample t-test. We used a stepwise selection logistic regression model (entry p<0.1, stay p<0.05) to assess the multivariable association between predictors and stroke subtype. Results: We included 341 patients (CES 189; LAS 152). As shown in Table 1, patients with CES were older (71.8±13.2 vs. 68.2±10.8 years, p<0.001), had more AF at presentation (29.4% vs. 3.4%, p<0.001), history of AF (40.2% vs. 6.6%, p<0.001), congestive heart failure (34.9% vs. 20.4%, p=0.0006), coronary artery disease (38.6% vs. 29.6%, p=0.019), larger left atrial size (3.9±0.8 vs. 3.4±0.6 cm, p<0.001) and lower left ventricular ejection fraction (LVEF 52.2±16.6% vs. 60.0±8.9%, p<0.001). In contrast, LAS was associated with more smoking (44.1% vs. 28.0%, p=0.024), carotid stenosis ≥50% (49.3% vs.14.9%, p<0.001) and peripheral arterial disease (PAD 17.1% vs. 10.1%, p=0.046). Significant multivariable predictors of CES were LVEF <50% [adjusted OR 5.31 (95% CI 2.43, 11.60); p<0.0001], history of AF [7.29 (2.81, 18.92); p<0.0001], rhythm AF [4.94 (1.51, 16.23); p=0.008], age >70 years [1.91 (1.11, 3.29); p=0.020] and COPD [2.07 (1.05, 4.07); p=0.036]; while PAD [0.31 (0.14, 0.72); p=0.006] and history of atrial flutter [0.15 (0.03, 0.94); p=0.04] predicted LAS. Conclusions: CES is distinguished by presence of reduced LVEF, AF, older age and COPD while LAS has more PAD and atrial flutter. These characteristics could be used in personalizing stroke prevention strategies targeted specifically for CES vs. LAS.