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Published on: January 6, 2011
Sex Differences in Outcomes of Acute Myocardial Injury After Stroke
Michela Rosso1, Helena Stengl2,3,4, Ramanan Ganeshan2,3
1Department of Neurology University of Pennsylvania Philadelphia PA USA.
Insights
Acute myocardial injury after ischemic stroke is more prevalent in women and is linked to higher mortality and disability. Sex-specific cutoffs for cardiac troponin T did not improve outcome prediction in this study.
Area of Science:
- Cardiology
- Neurology
- Sex Differences in Medicine
Background:
- Sex differences in cardiovascular disorders are well-established.
- The relationship between acute myocardial injury and mortality after ischemic stroke is known, but sex-based differences in prevalence and outcomes remain unclear.
Purpose of the Study:
- To investigate whether the prevalence and outcomes of acute myocardial injury following ischemic stroke differ between women and men.
- To evaluate the prognostic value of acute myocardial injury for mortality and disability after ischemic stroke, considering sex-specific factors.
Main Methods:
- Prospective screening of consecutive patients with acute ischemic stroke using serial high-sensitivity cardiac troponin T measurements.
- Acute myocardial injury defined by elevated troponin T levels with a significant rise/fall; analysis also performed with sex-specific cutoffs.
- Logistic regression used to assess the association between acute myocardial injury and outcomes (mortality, modified Rankin Scale score).
Main Results:
- Of 1067 patients, 46% were women. Women presented with older age, higher rates of atrial fibrillation, pre-existing functional dependence, greater stroke severity, and more cardioembolic strokes.
- The crude prevalence of acute myocardial injury was higher in women (29%) compared to men (23%) (P=0.024).
- Acute myocardial injury was significantly associated with increased 7-day mortality, in-hospital mortality, and higher modified Rankin Scale scores at discharge in women, but not in men. Sex-specific cutoffs did not enhance prognostic value.
Conclusions:
- The prevalence of acute myocardial injury after ischemic stroke and its association with adverse outcomes, including mortality and disability, may be dependent on sex.
- Findings suggest a potential sex-specific impact of myocardial injury in stroke patients.
Background:
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 poststroke acute myocardial injury differ between women and men.
Methods And Results:
We prospectively screened consecutive patients with acute ischemic stroke and serial high-sensitivity cardiac troponin T measurements admitted to our center. Acute myocardial injury was defined as at least 1 high-sensitivity cardiac troponin T value above the upper reference limit (14 ng/L) with a rise/fall of >20%. Rates of acute myocardial injury were also calculated using sex-specific high-sensitivity cardiac troponin T cutoffs (women upper reference limit, 9 ng/L; men upper reference limit, 16 ng/L). Logistic regression analyses were performed to evaluate the association between acute myocardial injury and outcomes. Of 1067 patients included, 494 were women (46%). Women were older, had a higher rate of known atrial fibrillation, were more likely to be functionally dependent before admission, had higher stroke severity, and more often had cardioembolic strokes (all P values <0.05). The crude prevalence of acute myocardial injury differed by sex (29% women versus 23% men, P=0.024). Statistically significant associations between acute myocardial injury and outcomes were observed in women (7-day in-hospital mortality: adjusted odds ratio [aOR], 3.2 [95% CI, 1.07-9.3]; in-hospital mortality: aOR, 3.3 [95% CI, 1.4-7.6]; modified Rankin Scale score at discharge: aOR, 1.6 [95% CI, 1.1-2.4]) but not in men. The implementation of sex-specific cutoffs did not increase the prognostic value of acute myocardial injury for unfavorable outcomes.
Conclusions:
The prevalence of acute myocardial injury after ischemic stroke and its association with mortality and greater disability might be sex-dependent.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03892226.
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