Prognostic Significance of Troponin Elevation for Long-Term Mortality after Ischemic Stroke
Sung-Ho Ahn1,2, Ji-Sung Lee3, Young-Hak Kim4
1Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
Insights
Elevated troponin levels in acute ischemic stroke patients predict long-term mortality. This myocardial injury marker is linked to increased risks of death from stroke, cancer, and cardiac causes.
Area of Science:
- Neurology
- Cardiology
- Oncology
Background:
- Troponin elevation is common in ischemic stroke and associated with poor outcomes.
- The long-term prognostic significance of troponin elevation in these patients remains unclear.
Purpose of the Study:
- To investigate the prognostic value of troponin elevation for long-term mortality in ischemic stroke patients.
- To identify factors associated with troponin elevation following ischemic stroke.
Main Methods:
- Retrospective analysis of 1,692 ischemic stroke patients admitted within 24 hours.
- Serum cardiac troponin I levels measured at admission; mortality data from the National Death Certificate system.
- Median follow-up of 33 months.
Main Results:
- Troponin elevation (>0.04 ng/mL) found in 9.8% of patients.
- Associated with ischemic heart disease, heart failure, atrial fibrillation, cancer, and higher NIH Stroke Scale scores.
- Troponin elevation significantly increased risk of overall death (HR 1.83), including stroke-related (HR 1.71), cardiac-related (HR 3.17), and cancer-related (HR 1.98) mortality.
Conclusions:
- Troponin elevation in acute ischemic stroke is a significant predictor of long-term mortality.
- Increased mortality risk is driven by stroke and cancer in the first year, and cardiac causes in later periods.
Background And Purpose:
Troponin, a marker of myocardial injury, frequently increases and is related with poor outcome in ischemic stroke patients. However, the long-term outcome of this elevation remains uncertain. We, therefore, investigated the prognostic significance of troponin elevation for long-term mortality, and explored factors affecting troponin elevation after ischemic stroke.
Methods:
We retrospectively analyzed the medical data of stroke patients who were admitted within 24 hours of symptom onset and underwent a serum cardiac troponin I test at admission during a five-year period. Information on mortality as the outcome was obtained from the National Death Certificate system.
Results:
A total of 1,692 patients were eligible for inclusion with 33 months of median follow-up. Troponin elevation that exceeded the 99th percentile (>0.04 ng/mL) of values was detected in 166 patients (9.8%). After adjusting for baseline characteristics, troponin elevation was associated with previous ischemic heart disease and congestive heart failure, comorbid atrial fibrillation and active cancer, and increased National Institutes of Health Stroke Scale score. Patients with troponin elevation had a high risk of overall death (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.40-2.40), including stroke-related (HR 1.71, 95% CI 1.14-2.55), cardiac-related (HR 3.17, 95% CI 1.49-6.74), and cancer-related (HR 1.98, 95% CI 1.14-3.45) death than those without troponin elevation.
Conclusions:
Troponin elevation in the acute stage of ischemic stroke was associated with long-term mortality, mainly due to increased stroke- and cancer-related death in the first year and cardiacrelated death in the later period.
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