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Published on: July 3, 2014
Impact of Acute Myocardial Injury on Short- and Long-Term Outcomes in Patients With Primary Intracerebral Hemorrhage
Shenghui Ma1,2, Jiawen Li3, Qi Kong3
1Department of Cardiology The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou Zhejiang China.
Insights
Acute myocardial injury (AMI) is common in patients with intracerebral hemorrhage. This condition independently increases the risk of major adverse cardiac events and unfavorable outcomes within 90 days.
Area of Science:
- Cardiology
- Neurology
- Critical Care Medicine
Background:
- Myocardial injury frequently occurs after brain injury, but differentiating acute from chronic injury using serial cardiac troponin (cTn) measurements is understudied.
- The fourth Universal Definition of Myocardial Infarction established criteria for acute myocardial injury (AMI).
Purpose of the Study:
- To investigate the prevalence of AMI in patients with primary intracerebral hemorrhage.
- To determine the prognostic implications of AMI on cardiac and neurological outcomes.
Main Methods:
- Retrospective analysis of 600 patients with primary intracerebral hemorrhage admitted within 48 hours of symptom onset.
- Serial cTn measurements (admission and within 2 days) were used to define AMI (elevated cTn with >20% rise/fall).
- Outcomes included major adverse cardiac events (MACE) and 90-day unfavorable outcomes (modified Rankin Scale score ≥4), analyzed using Cox models, logistic regression, and Kaplan-Meier analysis.
Main Results:
- 115 out of 600 patients (19.2%) were diagnosed with AMI.
- AMI was an independent predictor of increased risk for MACE (aHR=1.69) and 90-day unfavorable outcomes (aOR=2.15).
Conclusions:
- Acute myocardial injury is a frequent complication in patients with intracerebral hemorrhage.
- AMI is significantly associated with adverse long-term cardiac events and short-term neurological outcomes.
Background:
Myocardial injury is common after brain injury; however, few studies have reported serial cardiac troponin (cTn) measurements to distinguish whether the myocardial injury is acute or chronic. The fourth Universal Definition of Myocardial Infarction introduced for the first time the criteria for acute myocardial injury (AMI). We aimed to investigate the prevalence and prognostic implications of AMI in primary intracerebral hemorrhage.
Methods And Results:
We retrospectively analyzed patients with primary intracerebral hemorrhage within 48 hours after symptom onset. All patients included had at least 2 cTn measurements: 1 obtained at the time of emergency admission and at least 1 more within the first 2 days of hospitalization. AMI was defined as an elevated cTn above the upper-reference limit (14 ng/L) along with a rise/fall >20%. Patients were followed for up to 5 years. Outcomes included major adverse cardiac events (MACEs; a composite of vascular death, nonfatal coronary events, and nonfatal stroke) and 90-day unfavorable outcomes (modified Rankin scale score ≥4). Cox proportional hazards models, multivariable logistic regression models, and Kaplan-Meier analyses were used to evaluate the association between AMI and outcomes. Of 600 patients included, 115 had AMI (19.2%). AMI independently conferred an increased risk for major adverse cardiac events (adjusted hazard ratio, 1.69 [95% CI, 1.12-2.53]) and 90-day unfavorable outcomes (adjusted odds ratio, 2.15 [95% CI, 1.26-3.67]) compared with patients without AMI.
Conclusions:
AMI is relatively common in patients with intracerebral hemorrhage and is associated with both long-term major adverse cardiac events and 90-day unfavorable outcomes.
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