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


中文翻译：

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机械取栓后 72 小时心率轨迹组及结果

背景和目的：机械血栓切除术（MT）后心率（HR）升高与不良结果风险增加相关。然而，MT 后的最佳人力资源管理仍不清楚。本研究旨在确定 MT 后具有不同 HR 轨迹的患者亚组，并探讨其与结果的关联。
方法：前瞻性招募2020年7月至2022年12月接受MT治疗的急性缺血性脑卒中患者。在MT治疗后72小时内每小时收集他们的心率指标。使用潜变量混合模型将受试者分为具有不同 HR 轨迹的五组。主要结局是 3 个月时功能结局不佳（mRS 评分 > 2）。其他结果是 3 个月时的全因死亡率（mRS 评分 = 6）。
结果：共纳入224例大血管闭塞患者，平均年龄65.2±14.0岁。 87 名患者的功能结果良好，137 名患者的功能结果较差。观察到五种不同的心率轨迹：低心率组（19.2%）、中度心率组（33.0%）、快速稳定心率组（20.5%）、持续高心率组（21.0%）和极高心率组（6.3%）。调整潜在混杂因素后，HR 轨迹组与 3 个月时功能不良结果独立相关（交互作用P = 0.022）。在快速稳定的 HR 组（比值比，3.18 [95% 置信区间，1.10-9.19]）和持续高 HR 组（比值比，5.55 [95% 置信区间，1.72-1.72]）中，功能结果不佳的风险增加。 17.87]）和非常高 HR 组（比值比，18.32 [95% 置信区间，2.20–95.52]），但不在中等组（比值比，1.50 [95% 置信区间，0.61–3.69]）中低心率组。轨迹组与 3 个月全因死亡率之间没有发现显着关联。
结论： MT 后前 72 小时内的 HR 可以分为不同的轨迹组，这些轨迹组与不良功能结果事件风险的关系不同。研究结果可能有助于识别未来人力资源控制试验的潜在候选人。

关键词:缺血性脑卒中, 心率轨迹, 机械取栓, 结局