Abstract TP170: Racial Disparities in Post-Stroke Major Adverse Cardiovascular Events (MACE): A Comparative Analysis of Black and White Patients Using Real-World Data

Background: Racial disparities in post-stroke (ischemic and hemorrhagic) outcomes remain a critical public health concern. This study compared the risk of major adverse cardiovascular events (MACE) and mortality between Black and White stroke survivors using a large-scale electronic health records database. Methods: A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network, comprising 154 healthcare organizations. We identified 916,976 White (Cohort A) and 221,742 Black (Cohort B) adult stroke survivors without prior myocardial infarction (MI), heart failure, or cancer. Propensity score matching (1:1) balanced baseline demographics and comorbidities, yielding 221,443 patients per cohort. Outcomes assessed included MI, heart failure, stroke recurrence, and death, analyzed via risk differences, survival analysis, and incidence rates over a 20-year follow-up. Results: After matching, Black stroke survivors had a higher risk of heart failure (Risk Difference RD -0.006, p<0.001; Hazard Ratio HR 0.873, 95% CI 0.852–0.895) and stroke recurrence (RD -0.019, p<0.001; HR 0.938, 95% CI 0.928–0.947) but lower all-cause mortality (HR 1.147, 95% CI 1.126–1.169) compared to White patients. No significant difference was observed in post-stroke MI risk (RD 0.000, p=0.367). Black patients also experienced higher stroke recurrence rates (mean 6.66 vs. 5.73 events, p<0.001) and shorter median time to recurrence (1,984 vs. 3,024 days). Conclusion: Racial disparities persist in post-stroke outcomes, with Black patients facing elevated risks of stroke recurrence and heart failure but lower mortality. These findings underscore the need for targeted interventions to address inequities in post-stroke care and secondary prevention.