The sex difference in early cardiac events following acute ischaemic stroke: an individual patient data pooled analysis from the VISTA database

Abstract Background Early cardiac events are common complications of acute ischaemic stroke, collectively termed stroke-heart syndrome (SHS). We compared sex differences in the incidence and specific presentations of SHS. Methods We analysed data from patients with acute ischaemic stroke in the Virtual International Stroke Trials Archive (VISTA). SHS was defined as cardiac complications occurring within 30 days of stroke, including acute coronary syndrome (ACS)/myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation (AF)/flutter (AFL), and cardiorespiratory arrest. We compared the incidence of SHS and each presentation between the sexes. To balance baseline characteristics, including the CHA2DS2-VA score, National Institutes of Health Stroke Scale at baseline, and history of AF, we applied propensity score matching (PSM) using three models. Results Among 6,849 patients (mean age 69±13 years; 46% female; CHA2DS2-VA score: 4.4±1.4), 1,350 (20%) developed SHS. After PSM, we compared 3,120 matched patients in each cohort. The overall incidence of SHS did not differ between sexes (cumulative incidence 95% confidence interval: 21.0% 19.5-22.4 in females vs. 21.0% 19.5-22.3 in males, p=0.900). However, females had a significantly higher incidence of AF/AFL than males (8.3% 7.3-9.3 vs. 6.3% 5.4-7.1, p=0.002), while males had a higher incidence of ACS/myocardial injury (1.3% 0.9-1.8 vs. 2.2% 1.7-2.7, p=0.010). These findings remained consistent across all three models. Conclusions Although the overall incidence of SHS was similar between sexes, the incidence of specific SHS presentations, such as acute coronary syndrome and atrial fibrillation, differed by sex.