Troponin and Mortality in Acute Ischemic Stroke

Study Questions:

What is the association between the positivity of cardiac troponin and echocardiogram testing within a large biracial acute ischemic stroke (AIS) population and post-stroke mortality?

Methods:

The investigators screened emergency department admissions from 2010 within a catchment area of 1.3 million, using International Classification of Diseases, Ninth Edition, discharge codes 430-436 and ascertained all physician-confirmed AIS cases by retrospective chart review. Hypertroponinemia was defined as elevation in cardiac troponin above the standard 99th percentile. Multiple logistic regression was performed, controlling for stroke severity, history of cardiac disease, and all other stroke risk factors.

Results:

Of 1,999 AIS cases, 1,706 (85.3%) had a cardiac troponin drawn and 1,590 (79.5%) had echocardiograms. Hypertroponinemia occurred in 353 of 1,706 (20.7%), and 160 of 1,590 (10.1%) had echocardiogram findings of interest. Among 1,377 who had both tests performed, hypertroponinemia was independently associated with echocardiogram findings (odds ratio [OR], 2.9; 95% confidence interval [CI], 2-4.2). When concurrent myocardial infarctions (3.5%) were excluded, hypertroponinemia was also associated with increased mortality at 1 year (35%; OR, 3.45; 95% CI, 2.1-5.6) and 3 years (60%; OR, 2.91; 95% CI, 2.06-4.11).

Conclusions:

The authors concluded that hypertroponinemia in the context of AIS without concurrent myocardial infarction was associated with structural cardiac disease and long-term mortality.

Perspective:

This study reports that hypertroponinemia is independently associated with both short- and long-term mortality to at least 3 years post-event among patients with AIS. The 3-year mortality rate of 60% among AIS patients with hypertroponinemia is of significant concern. Additional prospective studies are needed to determine whether routine cardiac evaluation or use of evidence-based medical therapies after hypertroponinemic AIS might reduce mortality in this high-risk population.

Clinical Topics: Acute Coronary Syndromes, Noninvasive Imaging, Prevention, ACS and Cardiac Biomarkers, Echocardiography/Ultrasound

Keywords: Acute Coronary Syndrome, Biological Markers, Cardiac Imaging Techniques, Echocardiography, Emergency Service, Hospital, International Classification of Diseases, Mortality, Myocardial Infarction, Myocardial Ischemia, Risk Factors, Secondary Prevention, Stroke, Troponin, Vascular Diseases


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