Abstract WMP79: Elevated Cardiac Troponin Levels In Patients With Non-traumatic Intracerebral Hemorrhage

Abstract

Background: Elevated cardiac troponin (cTn) levels are frequently encountered after intracerebral hemorrhage (ICH). In small cohorts, increased cTn was associated with in-hospital mortality. This study investigated the factors associated with elevated cTn in ICH cases and its relationship with outcome. Methods: We examined maximum cTn levels within 48 hours of hospital arrival in subjects enrolled in the Ethnic Racial Variations of Intracerebral Hemorrhage (ERICH) study. ERICH is a multi-center prospective study designed to examine ethnic variations in the risk, presentation, and outcomes of ICH. Elevated troponins were defined as cTn>0.1 mg/dL. Poor outcome was defined as modified Rankin Scale (mRS)≥3 at 3 months. We used logistic regression analysis with backward elimination to identify factors associated with elevated cTn levels and their relationship with poor outcome. The model included baseline demographics and clinical characteristics with at least weak association at baseline (p<0.2). Results are presented as odds ratios (OR) with their correspondent 95% confidence intervals (CI). Results: Of the 2061 included in the analysis, 39% were females and 177 (9.4%) had elevated cTn levels. The sample was 31% white, 33% Hispanic, and 36% black. In univariate analysis, blacks, prior use of opioids or marijuana, low Glasgow coma scale (GCS) on admission, and presence of intraventricular hemorrhage (IVH) were associated with elevated cTn (p<0.05 of all). In the multivariate model, blacks (OR=1.60, 95% CI 1.06-2.41), previous use of opiates (OR=2.27, 95% CI 1.23-4.21) or marijuana (OR=2.07, 95% CI 1.23-3.50), GCS on presentation (OR=0.90, 95% CI 0.87-0.94), presence of IVH (OR=1.42, 95% CI 1.01-2.00), and first measured systolic blood pressure (SBP) (OR=1.01, 95% CI 1.00-1.01) were associated with elevated cTn. Elevated cTn was associated with mRS>3 at 3 months (OR=2.17, 95% CI 1.43-3.30). Conclusion: Elevated cardiac troponin was associated with worse 3 month outcome independent of ICH severity. Surprisingly, sympathomimetic drug use was not associated with peak troponin while opiate and marijuana use were. Our results suggest the need to understand why blacks may have a greater susceptibility to myocardial injury after ICH.