Frequency, determinants and outcome of elevated troponin in acute ischemic stroke patients

International Journal of Cardiology, 05/24/2012

Scheitz JF et al. – Elevation of cardiac troponins (cTnT) occurs in every seventh patient with acute ischemic stroke and is independently associated with poor short–term outcome and mortality. Patients with strokes affecting the insular cortex are particularly prone to myocardial injury justifying intensive cardiac monitoring.

Methods

  • The authors performed a retrospective analysis including all consecutive ischemic stroke patients admitted to the stroke unit within 72h after symptom onset in a one-year period.
  • Multivariable logistic regression analyses were conducted to identify determinants of cTnT elevation and to detect factors independently associated with unfavorable short-term outcome (modified Rankin scale >2), major neurologic improvement (improvement of NIHSS>=8 or NIHSS 0–1) and in-hospital mortality.

Results

  • Admission cTnT levels were measured in 715 ischemic stroke patients.
  • Frequency of cTnT elevation was 14% (n=103).
  • Factors independently associated with increased cTnT were higher stroke severity (p=0.04), renal insufficiency (p<0.001), pre-existing coronary artery disease (p=0.03), hypercholesterolemia (p=0.02) and insular cortex involvement (p<0.001).
  • After exclusion of patients with renal insufficiency and coronary artery disease frequency of cTnT elevation was 10% (n=44) and only insular cortex involvement remained significantly associated.
  • Increased cTnT on admission was an independent predictor of unfavorable outcome (adjusted odds ratio 2.65 [95% confidence interval 1.29–5.46]) and in-hospital mortality (4.51 [1.93–10.57]).
  • There was a trend towards a negative association of cTnT elevation with major neurologic improvement (0.54 [0.27–1.07]).

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