[Association between dynamic elevation of high-sensitivity cardiac troponin T and functional outcomes in patients...

To investigate the association between in-hospital dynamic elevation of high-sensitivity cardiac troponin T (hs-cTnT) and early neurological deterioration (END) as well as 3-month functional outcomes in patients with acute ischemic stroke (AIS).

Data of AIS patients who underwent two hs-cTnT measurements during hospitalization between March 2017 and November 2024 were extracted from the Comparison Influence to Prognosis of CTP and MRP in AIS Patients (CIPPIS) database (NCT03367286) for retrospective analysis. Patients were categorized into a dynamic elevation group and a non-elevation group based on whether their hs-cTnT increased by more than 20% from the baseline level. The incidences of END and 3-month functional independence were compared between the two groups. END was defined as a ≥4-point increase in the National Institutes of Health Stroke Scale (NIHSS) score within 7 days of onset, and functional independence was defined as a modified Rankin Scale (mRS) score 0-2. Binary logistic regression was used to analyze the relationship between hs-cTnT dynamic elevation and the outcomes. Sensitivity analysis (excluding patients with acute myocardial infarction or severe renal dysfunction) and subgroup analyses were performed to assess the robustness of the findings.

A total of 1049 patients were included (median age 73 years). Among them, 406 patients (38.7%) were female, 226 patients (21.5%) exhibited hs-cTnT dynamic elevation. Compared with the non-elevation group, the dynamic elevation group had a significantly higher incidence of END (9.71% vs. 15.42%, P<0.05) and lower proportions of patients with 3-month mRS scores of 0-1 (37.75% vs. 26.57%, P<0.01), 0-2 (48.71% vs. 36.71%, P<0.01), and 0-3 (63.87% vs. 55.56%, P<0.05). The 3-month all-cause mortality was also higher in the dynamic elevation group (9.20% vs. 14.01%, P<0.05). After adjusting for confounders (including age, sex, baseline NIHSS score, baseline hs-cTnT level, TOAST classification, and reperfusion therapy), dynamic elevation of hs-cTnT remained independently associated with a higher risk of END (adjusted OR=1.73, 95%CI: 1.07-2.82, P<0.05) and lower odds of achieving 3-month mRS scores of 0-1 (adjusted OR=0.65, 95%CI: 0.44-0.96, P<0.05) and 0-2 (adjusted OR=0.67, 95%CI: 0.47-0.97, P<0.05). The results were consistent in sensitivity analysis, and no significant interactions were observed across various subgroups (all interactions P>0.05).

In patients with AIS, dynamic elevation of hs-cTnT is independently associated with an increased risk of END and poorer 3-month functional outcomes. This association may reflect the adverse impact of acute myocardial injury on stroke prognosis.