Background:
Stroke is a serious complication of infective endocarditis (IE), with unique management challenges. To better inform risk stratification, service planning, and clinical practice, we conducted a systematic review of stroke incidence in patients presenting with infective endocarditis.
Methods:
MEDLINE and Embase were searched from 01/01/2000 to 31/12/2025 with keywords “ischaemic stroke” OR “haemorrhagic stroke” AND “infective endocarditis”. Inclusion criteria were cohort, registry-based, and cross-sectional studies reporting the incidence of stroke in patients with IE. Paediatric populations and animal studies were excluded.
Screening of titles, abstracts, and full texts and data extraction was performed by 2 reviewers, resolving discrepancies by consensus. The ROBINS-E tool for epidemiological studies was used to assess risk of bias. A narrative synthesis was planned a priori due to anticipated high heterogeneity. The study protocol was registered with PROSPERO (CRD420251276322). Reporting adhered to PRISMA guidelines.
Results:
After duplication removal, 1414 Abstracts/Titles were screened and 359 full-texts reviewed. 10 studies reported incidence of IE in populations presenting with stroke. 167 studies from 37 countries reported stroke as a complication in populations with IE. 3 studies reported specifically on cardiac implantable device-associated IE. Incidence of stroke complicating IE ranged from 0-76.9%. Hospital-based cohorts reported higher mean incidence (12.1%, range 0-76.9%) than population-based cohorts (2.37%, range 1.4-54.9%). All studies had a risk of bias assessment of high to very high.
Conclusions:
IE confers a significant risk of stroke, particularly in hospital-based populations. Further research is required to understand factors associated with stroke risk and to develop prevention strategies.