We sought to examine nationwide outcomes of patients with infective endocarditis (IE) and acute ischemic stroke (AIS) to characterize clinical features, outcomes, and risks associated with intravenous thrombolysis (IVT) and endovascular therapy (EVT).

A retrospective cross-sectional study was conducted using data from the National Inpatient Sample (NIS) database between 2015 and 2022. Our population included patients in the United States hospitalized with AIS and reported NIH Stroke Scale (NIHSS). Propensity score-based inverse probability of treatment weighting (IPTW) adjusted for confounding factors, including stroke severity. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for all outcomes.

Among 1,733,390 AIS hospitalizations, 4,085 (0.2%) were subsequently diagnosed with IE. Following IPTW, IE-AIS demonstrated higher odds of inpatient mortality (aOR: 2.54 [1.95-3.30], p<0.001) and lower odds of routine discharge (0.263 [0.204-0.340], p<0.001). IE-AIS patients were more likely to receive EVT (1.36 [1.10-1.70], p<0.001) and less likely to receive IVT (0.347 [0.275-0.438], p<0.001).  Compared to patients with IE-AIS who did not receive EVT or IVT and had NIHSS > 5, EVT was associated with decreased mortality (0.739 [0.558-0.978], p=0.034), increased routine discharge (2.18 [1.46-3.24], p<0.001), and increased hemorrhagic transformation (1.96 [1.54-2.49], p<0.001).