Abstract
BackgroundElevated levels of cardiac troponin T (cTnT) have been associated with unfavorable outcomes in cardiac patients. However, no studies, to date, have discussed the prognostic value of high‐sensitivity cTnT (hs‐cTnT) in thrombolyzed patients with acute ischemic stroke (AIS).HypothesisWe hypothesized that elevated levels of hs‐cTnT would be associated with poorer clinical outcomes in AIS patients treated with intravenous tissue‐type plasminogen activator (IV tPA).MethodsFrom January 2017 to February 2018, a total of 241 AIS patients treated with IV tPA within 4.5 hours of onset were recruited. On admission, patients were stratified into either normal or elevated hs‐cTnT groups according to a cutoff value of 14 ng/L. Multivariable logistic regression analyses were conducted to identify determinants of hs‐cTnT elevation and to detect whether elevated hs‐cTnT was associated with disability and/or mortality.ResultsIn multivariable regression analysis, older age (P < .001) and stroke etiology (P = .024) were significantly associated with elevated hs‐cTnT levels. After adjusting for demographic and clinical characteristics, hs‐cTnT elevation was still significantly associated with 14‐day major disability (modified Rankin Scale (mRS) 3‐5, model 1, P = .019, odds ratio [OR] 2.677; model 2, P = .015, OR 2.834), 14‐day composite unfavorable outcome (mRS 3‐6, model 1, P = .005, OR 3.525; model 2, P = .003, OR 3.976), 30‐day mortality (P = .049, OR 4.545) and 90‐day mortality (P = .049, OR 3.835).ConclusionsElevation of hs‐cTnT at admission is associated with an increased risk of 90‐day mortality in AIS patients treated with IV tPA.
Highlights
Cardiac complications, such as congestive heart failure, acute coronary syndrome (ACS), and arrhythmia occur in 20% of acute ischemic stroke (AIS) patients and are associated with unfavorable outcomes.[1]
We found that stroke etiology, according to TOAST criteria, showed a statistical difference between the two groups, after multivariable regression analysis (P = .024, odds ratio (OR) 0.641, 95% confidence interval (CI) 0.435-0.944), indicating that patients with elevated high-sensitivity cardiac troponin T (cTnT) (hs-cTnT) were more prone to present with cardioembolic etiology (Table 4)
We found that in AIS patients who underwent intravenous thrombolysis, (a) elevation of serum hs-cTnT was associated with 90-day mortality after treatment, (b) elevation of hs-cTnT was not associated with Early neurological deterioration (END) or any type of hemorrhagic transformation (HT), (c) older age and TOAST etiology were associated with hs-cTnT elevation, and (d) hs-cTnT ≥15.4 ng/L predicts mortality with acceptable sensitivities and specificities
Summary
Cardiac complications, such as congestive heart failure, acute coronary syndrome (ACS), and arrhythmia occur in 20% of acute ischemic stroke (AIS) patients and are associated with unfavorable outcomes.[1]. Catecholamine surge secondary to a sympathetic disturbance in AIS may cause cTn leakage and subsequent cardiomyocyte dysfunction.[9,10] Infarction in right insular cortex is associated with myocardial injury indicated by the elevation of cTnT.[11] In some instances, preexisting myocardial infarction associated with cTn elevation may complicate unfavorable outcomes of AIS.[12] As a result, the American Heart Association/American Stroke Association (AHA/ASA) guidelines suggest a Level I recommendation of cTn assessment in all AIS patients.[13] the measurement of high-sensitivity cTn (hs-cTn) has been increasingly utilized. A cutoff value of hs-cTnT to predict unfavorable outcomes after IV tPA was calculated by a prediction model
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