Abstract 140: Risk of Recurrent Ischemic Stroke Among Patients with Cryptogenic Stroke and Left Ventricular Ejection Fraction <50%: A Secondary Analysis of the ARCADIA Trial

• DOI: 10.1161/str.56.suppl_1.140
• Publication Date: 2025-01-30T10:08:16Z
• Authors: Dinesh Jillella; Richa Sharma; Cenai Zhang; Mitchell Elkind; Hooman Kamel; Richard Kronmal; W Longstreth; David Tirschwell; Marco Di Tullio; Alexander Merkler; Fadi Nahab
• Keywords: Stroke; Arcadia; Secondary Prevention

Background: Nearly one-quarter of ischemic strokes (IS) in the U.S. are recurrent. We aimed to determine risk recurrent IS associated with reduced left ventricular ejection fraction (LVEF) patients enrolled ARCADIA trial. Methods: performed a post-hoc exploratory analysis trial, phase III RCT 1,015 cryptogenic stroke atrial cardiopathy from February 2018 2023. Those LVEF &lt;30% were not eligible. dichotomized into &lt;50% and &gt; 50% built adjusted Cox proportional hazard models estimate ratio (HR) within each strata by treatment strategy apixaban versus aspirin. Significance interaction was assessed after adjustment for imbalanced covariates found among these groups. Results: The analytic cohort comprised 963 participants, 74 (7.7%) ≥50% 889 (92.3%). Participants LVEF&lt;50% compared younger (65 vs 68 years, p=0.006), more likely male (63.5% 44.4%, p=0.002) non-White race (45.9% 23.8%, p&lt;0.001), have coronary artery disease (25.7% 8.9%, p&lt;0.001) CHF (33.8% 4.7%, higher N-terminal pro-BNP (median 487 292 pg/mL, larger diameter index 2.1 1.9 cm, lower 43% 62%, p&lt;0.001); P-wave terminal force V1 similar. Recurrent occurred 10 (13.5%) 61 (6.9%) ≥ 50%. incidence rates per 100 person-years 7.1 (95% CI, 3.8-13.3) 3.9 3.0-5.0) In analysis, significantly (HR 2.23, 95% CI 1.03-4.83). There no significant between stratum effect (p=0.35; Figure). nominally randomized than aspirin 0.11, C.I. 0.01-1.12), EF 0.87, 0.52-1.45) but did reach statistical significance. Conclusion: ≥50%. different Further study is needed identify optimal anti-thrombotic dysfunction.