Abstract 5625: One-year Mortality in Patients With Troponin I Elevation in an Acute Ischemic Cerebrovascular Event in the Absence of an Acute Coronary Syndrome or Pulmonary Edema

Abstract

Introduction: Troponin (TnI) elevation in patients with an acute ischemic cerebrovascular event (AICVE) has a poor prognosis and is often thought to be secondary to cardiac failure {(left ventricular ejection fraction (EF) < 55%} or renal failure (creatinine >1.3 mg/dL). However, the prognosis is not well defined in the absence of cardiac or renal failure. Hypothesis: We hypothesize that patients with an elevated TnI (≥0.08 mcg/L) in an AICVE have an increased risk of one-year mortality, even in the absence of cardiac or renal failure. Methods: Three hundred consecutive patients who were admitted with an acute ischemic stroke or a transient ischemic attack in the absence of an acute coronary syndrome or pulmonary edema from january 2004 to january 2006 were studied. Hazard ratios for all-cause mortality were determined using multivariate Cox Proportional hazards analysis employing multiple variables between patients with and without TnI elevation. Results: The final cohort consisted of 207 patients with a mean age 70 ± 14 years, 62% were females. There was a 33% occurrence of TnI elevation among the entire group of 207 patients (Gr. A) and a 20% occurrence among patients, who had a normal EF(≥ 55%) and a creatinine ≤ 1.3mg/dL (Gr. B, n=91). The one-year mortality was significantly higher in patients with TnI elevation (58% in Gr. A; 42% in Gr. B) as compared to the patients without TnI elevation (20% in Gr. A; 11% in Gr. B). Conclusions: The presence of TnI elevation in patients with an AICVE is a significant independent multivariate predictor of one-year mortality in the presence or absence of cardiac or renal failure. It may be plausible that a recent silent myocardial infarction or other neurohormonal mechanisms may cause troponin elevation apart from cardiac or renal failure in the setting of an AICVE. TnI elevation and one-year mortality