title: The prognostic significance of troponin I elevation in acute ischemic stroke.
abstract: BACKGROUND
  The significance of cardiac troponin I (TnI) levels in patients with acute ischemic stroke remains unclear.
  
  
  METHODS
  Data were prospectively collected on 1718 patients with acute ischemic stroke (2009-2010). Patients with positive TnI (peak TnI ≥0.1 μg/L) were assigned to the myocardial infarction (MI) group if they met diagnostic criteria. The remaining patients with positive TnI were assigned to the no-MI group. Patients were followed up for 1.4 ± 1.1 years. Primary outcome was inhospital and long-term all-cause mortality.
  
  
  RESULTS
  Positive TnI was present in 309 patients (18%), 119 of whom (39%) were classified as having MI. Positive TnI was independently associated with older age, hypertension, smoking, peripheral arterial disease, heart failure, higher systolic blood pressure, higher serum creatinine, and lower heart rate (P < .01). Patients with MI had the highest inpatient mortality (P < .001) and the lowest survival rate by Kaplan-Meier analysis (P < .0001). Peak TnI greater than or equal to 0.5 μg/L, particularly if satisfying criteria for MI, was independently associated with long-term mortality (P < .0001); peak TnI less than 0.5 μg/L alone was not when adjusted for covariates.
  
  
  CONCLUSIONS
  Positive TnI greater than or equal to 0.5 μg/L in patients with acute ischemic stroke was independently associated with worse outcomes. Patients with diagnosis of MI represent a particularly high-risk subgroup.
authors.affiliation: Heart and Vascular Institute, UPMC, Pittsburgh, PA 15221.
authors.forename: Omar
authors.initials: O
authors.lastname: Batal
authors.affiliation: Heart and Vascular Institute, UPMC, Pittsburgh, PA 15221.
authors.forename: Jacob
authors.initials: J
authors.lastname: Jentzer
authors.affiliation: General Internal Medicine, UPMC, Pittsburgh, PA 15221.
authors.forename: Bhavna
authors.initials: B
authors.lastname: Balaney
authors.affiliation: School of Medicine, University of Pittsburgh, Pittsburgh, PA 15221.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Kolia
authors.affiliation: Heart and Vascular Institute, UPMC, Pittsburgh, PA 15221.
authors.forename: Gavin
authors.initials: G
authors.lastname: Hickey
authors.affiliation: Department of Statistics, University of Pittsburgh, Pittsburgh, PA 15221.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Dardari
authors.affiliation: Department of Neurology, UPMC, Pittsburgh, PA 15221.
authors.forename: Vivek
authors.initials: V
authors.lastname: Reddy
authors.affiliation: Department of Neurology, UPMC, Pittsburgh, PA 15221.
authors.forename: Tudor
authors.initials: T
authors.lastname: Jovin
authors.affiliation: Department of Neurology, UPMC, Pittsburgh, PA 15221.
authors.forename: Maxim
authors.initials: M
authors.lastname: Hammer
authors.affiliation: Heart and Vascular Institute, UPMC, Pittsburgh, PA 15221.
authors.forename: John
authors.initials: J
authors.lastname: Gorcsan
authors.affiliation: Heart and Vascular Institute, UPMC, Pittsburgh, PA 15221. Electronic address: schmidhoferm@upmc.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Schmidhofer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000150:complications; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology / Q000401:mortality; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000097:blood* / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D003404:Creatinine
keywords: Acute ischemic stroke; Cardiac troponin; Coronary artery disease; Myocardial infarction