Heart rate and clinical outcome after endovascular treatment in patients with anterior versus posterior circulation large vessel occlusion

Background: The prognostic significance of resting heart rate (HR) in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) after endovascular treatment (EVT) remains to be elucidated. Objectives: To determine whether HR is differentially associated with functional outcomes in patients dichotomized by anterior (ACS) or posterior circulation stroke (PCS) after successful reperfusion. Design: A multicenter retrospective cohort study. Methods: We retrospectively analyzed consecutive successfully recanalized LVO-AIS patients with complete HR recordings at admission, 30 min, 12 h, 24 h, and 48 h post-EVT. A good outcome was defined as modified Rankin Scale (mRS) 0-2 for ACS or mRS 0-3 for PCS at 3 months. Binary logistic regression and receiver operating characteristic analyses were used to assess associations and predictive performance. Results: Among 505 patients (362 ACS, 143 PCS), lower HR at 12, 24, and 48 h post-EVT was independently associated with good outcomes in both groups. HR showed higher predictive accuracy for PCS (AUC: 0.872-0.885) than for ACS (AUC: 0.732-0.762). Conclusion: HR following EVT independently predicts functional outcome in LVO patients, demonstrating stronger predictive value for PCS than ACS. These results highlight the potential of HR monitoring in post-EVT management.