ABSTRACT NUMBER: ESOC2026A321 CRYPTOGENIC STROKE IN WOMEN: IMPACT OF INSERTABLE CARDIAC MONITORING IN THE STROKEWISE COHORT STUDY

Abstract Background and aims The clinical value of insertable cardiac monitors (ICM) for detecting atrial fibrillation (AF) and guiding anticoagulation after cryptogenic stroke in women remains uncertain. We evaluated associations between ICM and AF detection, recurrent stroke, mortality, and major bleeding. Methods We recruited women with cryptogenic stroke from two university hospitals (2016–2023). Patients received ICM in one centre, while standard non-invasive follow-up in the other. Primary outcomes were AF detection and recurrent stroke at 1 and 2 years. Secondary outcomes included mortality, combined stroke/death, cardiovascular events, oral anticoagulation, and major bleeding. Analyses used logistic regression and Cox models adjusted for prespecified vascular risk factors. Results Among 475 women (mean age 73±12 years; ICM n = 262), AF was detected in 36% (ICM) vs 9% (controls) (OR 6.9; 95% CI 3.7–13.5; p < 0.001). Time-to-event analyses showed no significant differences in recurrent stroke (HR 1.8; 95% CI 0.78–4.36; p = 0.17), mortality (HR 0.88; 95% CI 0.58–1.58; p = 0.88) or the composite outcome (HR 0.96; 95% CI 0.60–1.50; p = 0.85). However, fixed-time analyses indicated lower 2-year mortality with ICM (OR 0.40; 95% CI 0.16–0.94; p = 0.036) and fewer major bleeding events (OR 0.19; 95% CI 0.06–0.52; p = 0.002). Age and troponinT independently predicted adverse outcomes. Conclusions ICM increased AF detection and enabled safe anticoagulation, with possible reductions in mortality and bleeding but no clear effect on recurrent stroke.These findings support its potential role in secondary prevention in women with cryptogenic stroke. Conflict of interest Jannicke Koldéus-Falch, nothing to disclose.