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Updated: Feb 22, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
INTERMACS Analysis of Stroke During Support With Continuous-Flow Left Ventricular Assist Devices: Risk Factors and
Deepak Acharya1, Renzo Loyaga-Rendon2, Charity J Morgan3
1Section of Advanced Heart Failure and Transplant Cardiology, University of Alabama at Birmingham, Birmingham, Alabama.
Insights
Stroke is a significant risk for patients receiving a left ventricular assist device (LVAD). Identifying pre-implant predictors like female sex and higher blood pressure can help mitigate this serious complication.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Stroke is a major complication following left ventricular assist device (LVAD) implantation.
- Pre-implantation factors influencing stroke risk are not well understood, necessitating further investigation.
Purpose of the Study:
- To evaluate pre-implant predictors of stroke in patients undergoing LVAD support.
- To quantify stroke-related morbidity and mortality in this patient population.
Main Methods:
- Analysis of data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) for continuous flow LVAD recipients (May 2012 - March 2015).
- Evaluation of pre-operative risk factors, stroke incidence, and associated outcomes.
Main Results:
- 10.57% of 7,112 LVAD patients experienced at least one stroke, with an incidence rate of 0.123 strokes per patient-year.
- Hemorrhagic strokes were associated with significantly worse 30-day survival (45.3%) compared to ischemic strokes (80.7%).
- Pre-implant predictors included female sex, elevated systolic blood pressure, heparin-induced thrombocytopenia, intra-aortic balloon pump use, and primary cardiac diagnosis.
Conclusions:
- Despite advancements in LVAD technology, stroke remains a substantial cause of morbidity and mortality.
- Further research is crucial to develop strategies for reducing stroke risk in LVAD patients.
Objectives:
This study sought to evaluate predictors of stroke during left ventricular assist device (LVAD) support from data available prior to implantation, and quantify stroke-related morbidity and mortality.
Background:
Stroke is a major complication after LVAD. Pre-implant factors that influence stroke are not well understood.
Methods:
We evaluated all patients in INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) who were implanted with continuous flow LVADs from May 1, 2012, to March 31, 2015. Pre-operative risk factors for stroke and stroke incidence, morbidity, and mortality were analyzed.
Results:
During the study period, 7,112 patients underwent continuous flow LVAD placement. Median follow-up was 9.79 months (range 0.02 to 34.96 months). Of all patients, 752 (10.57%) had at least 1 stroke, with an incidence rate of 0.123 strokes per patient-year. A total of 447 (51.38%) strokes were ischemic and 423 (48.62%) were hemorrhagic. Patients with hemorrhagic stroke had worse survival than those with ischemic strokes (30-day survival: 45.3% vs. 80.7%; p < 0.001). Of patients with a first stroke, 13% had a second stroke. Pre-implant predictors of stroke were female sex (hazard ratio [HR]: 1.51; 95% confidence interval [CI]: 1.25 to 1.82; p < 0.001), pre-implant systolic blood pressure (HR: 1.01; 95% CI: 1.00 to 1.01; p = 0.002), heparin-induced thrombocytopenia (HR: 3.68; 95% CI: 1.60 to 8.47; p = 0.002), intra-aortic balloon pump (HR: 1.21; 95% CI: 1.01 to 1.46; p = 0.043), and primary cardiac diagnosis (ischemic/other/unknown) (p = 0.040).
Conclusions:
Despite improvements in LVAD technology, stroke-related morbidity and mortality is substantial. Further investigation is necessary to decrease the risk of this devastating complication.
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