Rising Cardiac Troponin: A Prognostic Biomarker for Mortality After Acute Ischemic Stroke

Area of Science:

• Cardiology
• Neurology
• Biomarkers

Background:

• Elevated cardiac troponin (cTn) is common in acute ischemic stroke (AIS), affecting 10-30% of patients and correlating with poor outcomes.
• Serial cTn measurements distinguish dynamic patterns (rise/fall >20%) indicating acute myocardial injury from nondynamic patterns attributed to chronic conditions.

Purpose of the Study:

• To investigate the impact of the direction of cardiac troponin (cTn) change—rising versus falling—on mortality and functional outcomes in patients with acute ischemic stroke (AIS).

Main Methods:

• Retrospective analysis of 300 patients with AIS and elevated cTn from 5 stroke centers, with serial measurements within 48 hours.
• Categorization of cTn patterns into rising (>20% increase), falling (>20% decrease), or nondynamic (≤20% change).
• Logistic regression used to assess associations between cTn patterns and 7-day mortality and unfavorable discharge disposition.

Main Results:

• A rising cTn pattern was observed in 72 patients, falling in 66, and nondynamic in 162.
• Acute myocardial infarction was diagnosed in 54% of patients with rising cTn versus 33% with falling cTn (P<0.01).
• Rising cTn independently associated with higher 7-day mortality (aOR=32) and unfavorable discharge disposition (aOR=2.5) compared to nondynamic patterns.

Conclusions:

• A rising cardiac troponin (cTn) pattern in patients with acute ischemic stroke (AIS) is an independent predictor of increased mortality.
• Rising cTn levels are also significantly associated with unfavorable discharge disposition in AIS patients.