Frequency, determinants and outcome of elevated troponin in acute ischemic stroke patients.
BACKGROUND
Myocardial injury indicated by elevation of cardiac troponins (cTnT) can be observed in acute ischemic stroke patients. Frequency, determinants and prognostic value are still unsettled.


METHODS
We performed a retrospective analysis including all consecutive ischemic stroke patients admitted to our stroke unit within 72 h 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]).


CONCLUSIONS
Elevation of 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.
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, 10117 Berlin, Germany. jan-friedrich.scheitz@charite.de
Jan F
JF
Scheitz
Matthias
M
Endres
Hans-Christian
HC
Mochmann
Heinrich J
HJ
Audebert
Christian H
CH
Nolte
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D016896:Treatment Outcome; D020107:Troponin T / Q000096:biosynthesis / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T