A novel clinical perspective on subarachnoid hemorrhage complicated by myocardial injury: independent predictors and short-term prognostic assessment.

Objective: To identify clinical, imaging, and laboratory factors associated with myocardial injury in patients with aneurysmal subarachnoid hemorrhage (aSAH) and to evaluate factors associated with short-term neurological outcomes at hospital discharge. Methods: In this single-center retrospective cohort study, clinical, laboratory, and imaging data were collected from 208 patients with aSAH admitted between 2022 and 2024. Univariable and multivariable logistic regression analyses, supported by Firth penalized logistic regression sensitivity analyses, were used to identify variables associated with myocardial injury and short-term neurological prognosis. Results: Right optic nerve sheath diameter (RONSD), procalcitonin (PCT), and neurogenic pulmonary edema (NPE) were independently associated with myocardial injury (adjusted ORs: 4.20, 1.45, and 18.87, respectively). Lower high-sensitivity C-reactive protein (hsCRP) levels, higher Glasgow Coma Scale (GCS) scores, younger age, and absence of hydrocephalus were associated with better short-term prognosis. Myocardial injury was not independently associated with poor short-term prognosis after adjustment. Conclusion: RONSD, PCT, and NPE may help identify patients with aSAH who are at increased risk of biomarker-defined myocardial injury. Short-term prognosis appears to be more strongly associated with inflammatory status, neurological impairment, age, and hydrocephalus than with myocardial injury alone. These single-center nomogram models should be considered preliminary and require external validation before routine clinical implementation.