Abstract
Cardiac troponins are specific biomarkers of cardiac injury. However, the prognostic usefulness of cardiac troponin in patients with acute ischemic stroke is still controversial. The objective of this meta-analysis was to investigate the association of cardiac troponin elevation with all-cause mortality in patients with acute ischemic stroke. PubMed and Embase databases were searched for relevant studies up to April 31, 2017. All observational studies reporting an association of baseline cardiac troponin-T (cTnT) or troponin-I (cTnI) elevation with all-cause mortality risk in patients with acute ischemic stroke were included. Pooled adjusted risk ratio (RR) and corresponding 95% confidence interval (CI) were obtained using a random effect model. Twelve studies involving 7905 acute ischemic stroke patients met our inclusion criteria. From the overall pooled analysis, patients with elevated cardiac troponin were significantly associated with increased risk of all-cause mortality (RR: 2.53; 95% CI: 1.83–3.50). The prognostic value of cardiac troponin elevation on all-cause mortality risk was stronger (RR: 3.54; 95% CI: 2.09–5.98) during in-hospital stay. Further stratified analysis showed elevated cTnT (RR: 2.36; 95% CI: 1.47–3.77) and cTnI (RR: 2.79; 95% CI: 1.68–4.64) level conferred the similar prognostic value of all-cause mortality. Acute ischemic stroke patients with elevated cTnT or cTnI at baseline independently predicted an increased risk of all-cause mortality. Determination of cardiac troponin on admission may aid in the early death risk stratification in these patients.
Highlights
Acute ischemic stroke is caused by permanent brain injury secondary to disruption of blood flow [1]
It should be noted that increase in cardiac troponin in acute stroke may be explained by comorbidities in some cases [8]
Inconsistent results [8-21] have been yielded on the association of elevated cardiac troponin level with all-cause mortality risk in patients with acute ischemic stroke
Summary
Acute ischemic stroke is caused by permanent brain injury secondary to disruption of blood flow [1]. Ischemic stroke remains the leading cause of disability and second cause of deaths throughout the world [4].Cardiac complications account for the leading cause of mortality in these patients [5]. An increase in the serum level of cTnT or cTnI is common in the acute phase of ischemic stroke [7], indicating a close relationship between stroke and cardiac damage. Inconsistent results [8-21] have been yielded on the association of elevated cardiac troponin level with all-cause mortality risk in patients with acute ischemic stroke. Published systematic review [22] did not establish the conclusion that troponin elevation was an independent prognostic factor in acute ischemic stroke patients. Prognostic value of cardiac troponin elevation in stroke patients remains conflicting
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