Abstract TMP65: Sex Differences in Outcomes of Acute Myocardial Injury After Stroke

Abstract

Introduction: Sex differences in presentation, treatment, and prognosis of cardiovascular disorders are well recognized. Although an association between acute myocardial injury and mortality after ischemic stroke has been demonstrated, it is unclear whether prevalence and outcome of post-stroke acute myocardial injury differ between women and men. Methods: We prospectively screened consecutive patients with acute ischemic stroke and serial high-sensitivity cardiac troponin T (hs-cTnT) measurements admitted to our center (January 2019-December 2020). Acute myocardial injury was defined as at least one hs-cTnT value above the upper reference limit (URL=14 ng/L) with a rise/fall of >20%. Additionally, rates of acute myocardial injury were calculated with sex-specific hs-cTnT cut-offs (women URL=9ng/L; men URL=16ng/L). Results: Of 1,067 patients included, 494 were women (46%). Women were older, had higher rate of known atrial fibrillation, were more likely to be functional dependent before admission, and had higher stroke severity (all p-values <0.05). The prevalence of acute myocardial injury differed by sex (29% women vs 23% men, P =0.024). In multivariate analysis, statistically significant associations between acute myocardial injury and outcomes were observed in women (7-day mortality: aOR=3.2 [1.07-9.3]; in-hospital mortality: aOR=3.3 [1.4-7.6]; mRS at discharge: aOR=1.6 [1.1-2.4]), but not in men (Fig.1). The implementation of sex-specific cut-offs did not increase the prognostic value of acute myocardial injury for unfavorable outcomes. The ROC-derived optimal cut-offs of hs-cTnT peak values for predicting of early mortality was higher than current URLs and sex-specific (women=29.5 ng/L vs men=66 ng/L; negative predictive value: 98.46% and 99.23%) (Fig.2). Conclusions: The prevalence of acute myocardial injury after ischemic stroke and its association with mortality and unfavorable functional outcome might be sex-dependent.