Department of Neurology University of Pennsylvania Philadelphia PA USA.
Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany.
J Am Heart Assoc. 2024 Mar 5;13(5):e032755. doi: 10.1161/JAHA.123.032755. Epub 2024 Feb 27.
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.
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 values <0.05). The crude prevalence of acute myocardial injury differed by sex (29% women versus 23% men, =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.
The prevalence of acute myocardial injury after ischemic stroke and its association with mortality and greater disability might be sex-dependent.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03892226.
心血管疾病在表现、治疗和预后方面的性别差异是众所周知的。虽然已经证明急性心肌损伤与缺血性中风后的死亡率之间存在关联，但尚不清楚中风后急性心肌损伤的发生率和结果在女性和男性之间是否存在差异。
我们前瞻性筛选了连续入院的急性缺血性中风患者，并进行了连续的高敏心肌肌钙蛋白 T 测量。急性心肌损伤定义为至少有 1 次高敏心肌肌钙蛋白 T 值高于上参考限（14ng/L），且升高/降低幅度 >20%。还使用性别特异性高敏心肌肌钙蛋白 T 截断值（女性上参考限为 9ng/L；男性上参考限为 16ng/L）计算急性心肌损伤的发生率。进行逻辑回归分析，以评估急性心肌损伤与结局之间的关联。在纳入的 1067 例患者中，494 例为女性（46%）。女性年龄较大，已知心房颤动发生率较高，入院前功能依赖性更高，中风严重程度更高，心源性脑卒更多（所有 P<0.05）。急性心肌损伤的粗患病率因性别而异（女性 29%，男性 23%，P=0.024）。在女性中，急性心肌损伤与结局之间存在统计学显著关联（7 天院内死亡率：调整优势比[OR]，3.2[95%CI，1.07-9.3]；院内死亡率：OR，3.3[95%CI，1.4-7.6]；出院时改良 Rankin 量表评分：OR，1.6[95%CI，1.1-2.4]），但在男性中则不然。实施性别特异性截断值并未增加急性心肌损伤对不良结局的预后价值。
缺血性中风后急性心肌损伤的发生率及其与死亡率和更高残疾的相关性可能存在性别依赖性。
