High-sensitivity troponin assay improves prediction of cardiovascular risk in patients with cerebral ischaemia
Raoul Stahrenberg1, Cord-Friedrich Niehaus, Frank Edelmann
1Department of Cardiology and Pneumology, University of Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany. stahrenberg@med.uni-goettingen.de
Insights
High-sensitivity troponin T (hsTropT) predicts vascular events and mortality in patients with cerebral ischaemia. Adding hsTropT to clinical scores significantly improves cardiovascular risk prediction for secondary prevention.
Area of Science:
- Cardiology
- Neurology
- Biomarker Research
Background:
- Clinical scores are standard for predicting cardiovascular risk in cerebral ischaemia patients.
- Blood biomarkers may offer enhanced predictive capabilities beyond existing clinical assessments.
Purpose of the Study:
- To evaluate the predictive value of five blood biomarkers for vascular events and mortality.
- To determine if biomarkers improve risk prediction when added to established clinical scores like ESRS, SPI-2, and NIH-SS.
Main Methods:
- Observational study of 197 patients with cerebral ischaemia (excluding atrial fibrillation).
- Baseline blood samples analyzed for five biomarkers.
- Biomarker predictive value assessed for combined vascular endpoint and all-cause mortality, with and without clinical scores (ESRS, SPI-2, NIH-SS).
Main Results:
- High-sensitivity troponin T (hsTropT) was the only biomarker independently predictive of vascular events and all-cause mortality.
- Patients with hsTropT above the median (6.15 ng/ml) had significantly higher vascular event rates (HR 3.86).
- hsTropT significantly improved risk prediction models incorporating ESRS, SPI-2, or NIH-SS, indicated by increased c-statistics.
Conclusions:
- hsTropT is a valuable predictor of vascular events and all-cause mortality in patients with acute cerebral ischaemia.
- Incorporating hsTropT into risk assessment models enhances prediction beyond traditional clinical scores, aiding secondary prevention strategies.
Background And Purpose:
Clinical scores are recommended for predicting cardiovascular risk in patients with cerebral ischaemia to inform secondary prevention. Blood biomarkers may improve prediction beyond clinical scores.
Methods:
Within the observational Find-AF trial (ISRCTN46104198), 197 patients >18 years of age with cerebral ischaemia and without atrial fibrillation had blood sampled at baseline. The predictive value of five biomarkers for a combined vascular endpoint (acute coronary syndrome, stroke, cardiovascular death) and all-cause mortality was determined, alone and in addition to the Essen Stroke Risk Score (ESRS), Stroke Prognostic Instrument 2 (SPI-2) and National Institutes of Health Stroke Scale (NIH-SS).
Results:
There were 23 vascular events (11.7%) and 13 deaths (6.6%) to 1 year follow-up. In multivariate analyses of all markers, only high-sensitivity troponin T (hsTropT) remained independently predictive for vascular events (p=0.045) and all-cause mortality (p=0.004). hsTropT was higher in patients with a vascular event (median 12.7 ng/ml vs 5.1 ng/ml), and patients with hsTropT above the median of 6.15 ng/ml had vascular events more frequently (HR 3.86, p=0.008). For prediction of vascular events as well as all-cause mortality, hsTropT significantly improved multivariate Cox regression models with ESRS, SPI-2 or NIH-SS. The c-statistic increased non-significantly from 0.695 (ESRS) or 0.710 (hsTropT) to 0.747 (ESRS+hsTropT) and from 0.699 (SPI-2) to 0.763 (SPI-2+hsTropT). No patient with a low-risk ESRS and an hsTropT below the median had a vascular event or died.
Conclusions:
hsTropT predicts vascular events and all-cause mortality in patients with acute cerebral ischaemia and improves prediction beyond established clinical scores.
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