Neurogenic Myocardial Injury Predicts Increased Mortality and Resource Utilization in Aneurysmal Subarachnoid Hemorrhage

Objective Myocardial injury complicates aneurysmal subarachnoid hemorrhage (aSAH) and impacts outcomes. However, current definitions often rely on specialized imaging that is difficult to operationalize in large datasets. We utilized a pragmatic, data-driven definition of neurogenic myocardial injury (NMI) to estimate its incidence, identify clinical predictors, and evaluate its association with mortality and resource utilization. Methods We performed a retrospective cohort study of 1,576 adult aSAH admissions in the MIMIC-IV database. We defined NMI as either cardiac troponin > 0.04 ng/mL within 72 hours of admission combined with a requirement for norepinephrine infusion, or explicit echocardiographic documentation of stress cardiomyopathy. We used multivariable logistic and linear regression to identify predictors of NMI and quantify associations with in-hospital mortality and length of stay (LOS). Results NMI occurred in 85 (5.4%) patients. Only 10.6% of these had explicit echocardiographic documentation of stress cardiomyopathy, suggesting this definition captures a broader high-risk phenotype. In multivariable analysis, coronary artery disease (aOR 4.79, 95% CI 2.70–8.46), chronic liver disease (aOR 4.66, 95% CI 1.95–10.22), and chronic lung disease (aOR 1.94, 95% CI 1.06–3.39) were independent predictors. Patients with NMI had significantly higher in-hospital mortality (56.5% vs 18.8%; OR 5.61, 95% CI 3.59–8.83) and longer ICU (mean 14.5 vs 9.4 days; p < 0.001) and hospital LOS (mean 20.1 vs 12.7 days; p < 0.001). Conclusion A pragmatic NMI phenotype based on troponin elevation and early vasopressor exposure identifies a distinct group of aSAH patients with fivefold higher mortality and significantly increased resource needs. This functional definition captures a clinically vulnerable cohort that may be overlooked by strict imaging-based criteria.