Dataset Information

Admission troponin-I predicts subsequent cardiac complications and mortality in acute stroke patients.

ABSTRACT:

Purpose

The importance of troponin elevation at stroke presentation remains uncertain. We aimed to assess whether baseline ultrasensitive Troponin I (hs-TnI) predicts cardiac complications and outcome in acute stroke patients.

Method

Stroke patients admitted within 6?h were consecutively enrolled from May 2013 to March 2014. Blood samples were taken at admission to determine hs-TnI by chemiluminescent microparticle immunoassay. hs-TnI?>?34.2 pg/ml (male) and >15.6 pg/ml (female) were considered elevated. Complications during in-hospital stay and outcome at 90 days were prospectively recorded. Independent predictors of cardiac complications (heart failure and acute coronary syndrome) and mortality were determined by logistic regression. The additional predictive value of hs-TnI was evaluated by integrated discrimination improvement index. A subanalysis was performed after excluding patients with previous cardiac diseases.

Findings

From 174 patients, 39(22%) had elevated hs-TnI, having these patients higher incidence of cardiac complications (57% versus 19%, p?=?0.004). hs-TnI was an independent predictor of cardiac complications (OR?=?16.1 (1.7-150.3)) together with diastolic blood pressure (OR?=?0.92 (0.86-0.99)). Addition of hs-TnI to clinical variables significantly improved discrimination (IDI?=?15.2% (7.8-22.7)). Subanalysis in patients without previous cardiac diseases showed similar results. Elevated hs-TnI was independently associated with 90 days mortality (OR?=?3.6 (1.3-9.4)), but addition of hs-TnI to clinical data did not result in an increased discrimination.

Discussion

The present study confers hs-TnI a 2b level of evidence as a diagnostic tool to predict cardiac complications in stroke. Absence of serial hs-TnI measurements and limited sample size are the main weaknesses of the study.

Conclusion

Patients with elevated baseline hs-TnI showed a higher frequency of cardiac complications and a higher mortality. Measurement of hs-TnI in acute stroke might be useful to identify patients at a high risk of cardiac complications and death.

SUBMITTER: Bustamante A

PROVIDER: S-EPMC6301235 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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Publications

Admission troponin-I predicts subsequent cardiac complications and mortality in acute stroke patients.

Bustamante Alejandro A Díaz-Fernández Belén B Pagola Jorge J Blanco-Grau Albert A Rubiera Marta M Penalba Anna A García-Berrocoso Teresa T Montaner Joan J

European stroke journal 20160621 3

<h4>Purpose</h4>The importance of troponin elevation at stroke presentation remains uncertain. We aimed to assess whether baseline ultrasensitive Troponin I (hs-TnI) predicts cardiac complications and outcome in acute stroke patients.<h4>Method</h4>Stroke patients admitted within 6 h were consecutively enrolled from May 2013 to March 2014. Blood samples were taken at admission to determine hs-TnI by chemiluminescent microparticle immunoassay. hs-TnI > 34.2 pg/ml (male) and >15.6 pg/ml (female) w ...[more]

PMID: 31008281

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Project description:Background and Purpose- American Heart Association guidelines recommend obtaining baseline troponin in all patients with acute ischemic stroke. Yet, there is a paucity of data on the prevalence of baseline troponin elevation and specifically its diagnostic yield for acute myocardial infarction (AMI) in patients presenting within the time window for thrombolysis. Methods- We retrospectively analyzed 1072 consecutive patients admitted for acute ischemic stroke or transient ischemic attack, who presented within 4.5 hours of last known well (LKW). Patients who had baseline cardiac troponin I (bcTnI) obtained within 72 hours from LKW (n=525) were included in the study. Multivariable logistic regression was conducted to determine factors independently related to an elevated bcTnI (>0.04 ng/mL). We calculated the area under receiver operator curves, sensitivity, and specificity, to determine the diagnostic accuracy of (i) the bcTnI for AMI stratified by the time to assessment and (ii) the best time cutoff for obtaining bcTnI. Results- Among included subjects, the median time from LKW to the bcTnI was 3.8 hours and 113 (21.5%) subjects had an elevated bcTnI. Assessment of bcTnI within 4.5 hours from LKW was significantly more often associated with normal values as compared to assessment between 4.5 and 72 hours (61.7% versus 38.3%; P=0.001). Fifteen (2.9%) patients were diagnosed with AMI. After adjustment for pertinent confounders, time to bcTnI assessment was independently associated with AMI (odds ratio, 1.04 [95% CI, 1.02-1.07] P=0.001). When stratified by time, bcTnI assessed within 4.5 hours had a sensitivity of 25% and specificity of 83.7% for AMI, whereas bcTnI assessment between 4.5 and 72 hours was associated with a sensitivity of 90.9% and specificity of 74.8%. Conclusions- Assessment of bcTnI after 4.5 hours from LKW was associated with greater diagnostic accuracy than testing within 4.5 hours. This information may inform routine clinical practice.

Project description:AimsThis study aimed to evaluate the cumulative high-sensitivity cardiac troponin T (hs-cTNT) from admission to 12 months after discharge and its association with mortality after 12 months among patients with acute heart failure (HF).MethodsWe used data from the China Patient-Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study (China PEACE 5p-HF Study), which enrolled patients hospitalized primarily for HF from 52 hospitals between 2016 and 2018. We included patients who survived within 12 months and had hs-cTNT data at admission (within 48 h of admission) and 1 and 12 months after discharge. To evaluate the long-term cumulative hs-cTNT, we calculated cumulative hs-cTNT levels and cumulative times of high hs-cTNT level. Patients were divided into groups according to the quartiles of cumulative hs-cTNT levels (Quartiles 1-4) and cumulative times of high hs-cTNT levels (0-3 times). Multivariable Cox models were constructed to examine the association of cumulative hs-cTNT with mortality during the follow-up period.ResultsWe included 1137 patients with a median age of 64 [interquartile range (IQR), 54-73] years; 406 (35.7%) were female. The median cumulative hs-cTNT level was 150 (IQR, 91-241) ng/L*month. Based on the cumulative times of high hs-cTNT levels, 404 (35.5%) patients were with zero time, 203 (17.9%) with one time, 174 (15.3%) with two times, and 356 (31.3%) with three times. During a median follow-up of 4.76 (IQR, 4.25-5.07) years, 303 (26.6%) all-cause deaths occurred. The increasing cumulative hs-cTNT level and cumulative times of high hs-cTNT level were independently associated with excess all-cause mortality. Compared with Quartile 1 group, Quartile 4 had the highest hazard ratio (HR) of all-cause mortality [4.14; 95% confidence interval (CI): 2.51-6.85], followed by Quartile 3 (HR: 3.35; 95% CI: 2.05-5.48) and Quartile 2 (HR: 2.47; 95% CI: 1.49-4.08) groups. Similarly, taking the patients with zero time of high hs-cTNT level as the reference, the HRs were 1.60 (95% CI: 1.05-2.45), 2.61 (95% CI: 1.76-3.87), and 2.86 (95% CI: 1.98-4.14) in patients who had one, two, and three times of high hs-cTNT level, respectively.ConclusionsElevated cumulative hs-cTNT from admission to 12 months after discharge was independently associated with mortality after 12 months among patients with acute HF. Repeated measurements of hs-cTNT after discharge may help monitor the cardiac damage and identify patients with high risk of death.

Dataset Information

Admission troponin-I predicts subsequent cardiac complications and mortality in acute stroke patients.

Purpose

Method

Findings

Discussion

Conclusion

Publications

Admission troponin-I predicts subsequent cardiac complications and mortality in acute stroke patients.

Similar Datasets

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