Abstract 59: Patients With Ischemic Stroke Have More Than Three-Fold Higher Rates of In-Hospital Mortality If Their Troponin is Elevated

Abstract

INTRODUCTION Stroke and heart disease have similar risk factors. Some patients admitted with acute stroke have elevated serum troponin levels concerning for simultaneous myocardial infarction (MI). However, the relationship between troponin elevation and stroke outcomes has not been described. METHODS We identified patients with ischemic stroke treated at a stroke network referral hospital whose data were available in the prospectively-collected “Get With The Guidelines” registry. Additional clinical data were obtained from the hospital laboratory, pharmacy, and billing departments. Characteristics of patients with and without abnormal troponin levels were compared, and logistic regression was used to evaluate the association between troponin elevation and mortality after accounting for clinical factors with nominal statistical significance (p<0.1 level) in the bivariate comparisons. RESULTS Of 1145 patients treated for ischemic stroke from 2008-2012, troponin was elevated in 199 patients (17.3%). Troponin-positive patients had more cardiovascular risk factors, cardiology consultations, and referral for coronary angiography and intervention (Table). Medical therapy was similar between groups, although patients with troponin elevation were more likely to be treated with intravenous heparin drip early during the hospitalization. Most notably, these individuals had markedly worse in-hospital mortality than those without troponin elevation (27% vs. 8%, p<0.001). This relationship persisted after adjustment for 14 clinical characteristics (odds ratio 4.28 [2.40-7.63]). Conclusions: Patients with ischemic stroke and simultaneous troponin elevation have greater burdens of medical comorbidities, higher use of cardiology services, and more than three-fold higher in-hospital mortality than patients without troponin elevation. Further study of these patients is needed to identify potential etiologies behind this high mortality rate.