High-Sensitivity Cardiac Troponin T and Cardiovascular Risk After Ischemic Stroke or Transient Ischemic Attack
Karin Willeit1, Christian Boehme1, Thomas Toell1
1Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Insights
High-sensitivity cardiac troponin T (hs-cTnT) predicts cardiovascular disease (CVD) risk in patients after ischemic stroke or transient ischemic attack. Elevated hs-cTnT levels are significantly associated with increased risk of stroke, CVD death, and all-cause mortality.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- High-sensitivity cardiac troponin T (hs-cTnT) is a known risk marker for cardiovascular disease (CVD) in general and high-risk populations.
- The prognostic value of hs-cTnT in patients with acute cerebrovascular events requires precise characterization.
Purpose of the Study:
- To precisely characterize the association between hs-cTnT levels and CVD risk in patients who have experienced an acute ischemic stroke or transient ischemic attack.
- To evaluate hs-cTnT as a predictor for composite CVD outcomes, including stroke, myocardial infarction, and CVD death.
Main Methods:
- Post hoc analysis of the STROKE-CARD trial data (NCT02156778) involving patients with acute ischemic stroke or transient ischemic attack (ABCD² score ≥3).
- Measurement of hs-cTnT on admission using Roche Elecsys assay (detection limit 5 ng/L).
- Quantification of hazard ratios (HRs) for a composite CVD outcome, adjusted for multiple clinical and demographic factors.
Main Results:
- Among 1,687 patients, hs-cTnT was detectable in 80.7% with a median level of 10 ng/L.
- A log-linear association was observed between hs-cTnT and CVD risk, with a multivariable-adjusted HR of 1.40 per 1-SD higher log-transformed hs-cTnT value (P < 0.001).
- Significant associations were found for stroke (HR 1.33, P=0.016), CVD death (HR 1.98, P < 0.001), and all-cause death (HR 1.93, P < 0.001).
Conclusions:
- Elevated hs-cTnT levels are significantly associated with increased cardiovascular disease risk in patients following acute ischemic stroke or transient ischemic attack.
- hs-cTnT serves as a valuable prognostic biomarker for predicting adverse cardiovascular outcomes, including stroke and mortality, in this patient cohort.
Background:
High-sensitivity cardiac troponin T (hs-cTnT) is associated with cardiovascular disease (CVD) risk in general and various high-risk populations.
Objectives:
The purpose of this study was to precisely characterize the association of hs-cTnT with CVD risk in patients following acute ischemic stroke or transient ischemic attack.
Methods:
We conducted post hoc analyses of data from the STROKE-CARD trial (NCT02156778), a pragmatic randomized controlled trial of a disease management program in patients with acute ischemic stroke or transient ischemic attack (ABCD2 score ≥3). We measured hs-cTnT on admission (Roche Elecsys, detection limit 5 ng/L) and quantified HRs for a composite CVD outcome (ie, stroke, myocardial infarction, CVD death) adjusted for age, sex, prior coronary heart disease, prior heart failure, diabetes, smoking, systolic blood pressure, and low- and high-density-lipoprotein cholesterol.
Results:
Among 1,687 patients (mean age, 69.3 ± 13.7 years; 40.7% female), hs-cTnT was detectable in 80.7%. Median hs-cTnT was 10 ng/L (IQR: 6-18 ng/L). Over a median follow-up of 12.1 months, 110 patients had a CVD event. The association of hs-cTnT level with CVD risk was of log-linear shape, with a multivariable-adjusted HR of 1.40 (95% CI: 1.15-1.70; P < 0.001) per 1-SD higher log-transformed hs-cTnT value. The strength of association was similar when further adjusted for other potential confounders and across clinically relevant subgroups. Corresponding outcome-specific HRs were 1.33 (95% CI: 1.06-1.68; P = 0.016) for stroke, 1.28 (95% CI: 0.69-2.37; P = 0.430) for myocardial infarction, 1.98 (95% CI: 1.43-2.73; P < 0.001) for CVD death, and 1.93 (95% CI: 1.54-2.41; P < 0.001) for all-cause death.
Conclusions:
High hs-cTnT is associated with increased CVD risk in ischemic stroke and transient ischemic attack patients.
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