The Significance of Troponin Elevation for the Clinical Course and Outcome of First-Ever Ischaemic Stroke

Lasek–Bal, Anetta; Kowalewska-Twardela, Teresa; Gąsior, Zbigniew; Warsz-Wianecka, Aldona; Haberka, Maciej; Puz, Przemysław; Ziaja, Damian

doi:10.1159/000365839

Cited by 18 publications

(14 citation statements)

References 28 publications

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“…Furthermore, elevated troponin levels are associated with an almost 2-fold increased risk of 5-year mortality [16]. In concordance with our study several studies showed that the short-term and long-term unfavorable outcome has been associated with increased troponin levels [6,11,12,[15][16][17].…”

Section: Discussionsupporting

confidence: 91%

“…The proportion of stroke patients with cardiac troponin level increase varies in several studies from 9.73% to 20.6% [11,12,15]. However, a smaller proportion of patients had increased troponin I levels in our study probably because higher cut-off levels were used.…”

Section: Discussioncontrasting

confidence: 53%

“…In their study the cut-off level for troponin I was 0.014 ng/mL [11]. Scheitz et al's study has found that the elevation of troponin T levels occurs in every seventh patients with acute ischemic stroke and is indepedently associated with poor short-term outcome measured by mRS (mRS >2) and in-hospital mortality [15].…”

Section: Discussionmentioning

confidence: 95%

“…It has been shown that highly specific myocardial necrosis markers such as troponin can be increased in stroke victims, a phenomenon that has been explained by several pathophysiologic mechanisms: primary cardiac damage with secondary cardioembolic cerebral ischemia or primary cerebral ischemia with secondary cardiac damage caused by increased levels of catecholamines (caused by sympathetic system activation) [7][8][9][10]. Some studies associate increased troponin levels with a certain localization of stroke: insular or right hemisphere [11][12][13]. Atrial fibrillation is more likely to be diagnosed after a detailed evaluation in patients with troponin increase [14].…”

Section: Discussionmentioning

confidence: 99%

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Impact of troponin I on outcome of ischemic stroke patients

Budinčević

Sremec²,

Črnac³

et al. 2017

Romanian Journal of Internal Medicine

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Introduction. Stroke is one of the leading causes of morbidity and mortality. Cardiac troponins have been found to be increased in other conditions apart from the cardiac diseases, such as stroke. The aim of the study was to assess the correlation between elevated troponin I levels and stroke outcome.Methods. This retrospective study included 198 acute ischemic stroke patients in whom troponin I levels have been obtained at admission. Exclusion criteria were concomitant acute coronary syndrome, congestive heart failure, pulmonary embolism, renal failure, rhabdomyolysis and septic conditions.Results. There was a statistically significant difference in the proportion of deaths during hospitalization (p = 0.041) and modified Rankin Scale scores (p = 0.016) between the group of patients with elevated troponin I levels and the control group. Prior ischemic strokes were more common in the group with elevated troponin I levels (p = 0.032). No other differences were observed.Conclusions. Our study showed that patients with elevated initial troponin I levels are associated with unfavorable outcome or death. Stroke may be associated with mild elevation of troponin levels, contrary to higher levels which are usually related to other conditions.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of troponin I on outcome of ischemic stroke patients

Budinčević

Sremec²,

Črnac³

et al. 2017

Romanian Journal of Internal Medicine

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“…Troponin is the most sensitive and specific biomarker for diagnosing AMI, and in previous studies of patients with stroke, AMI commonly has been identified by the measurement of serum troponin levels. Although the pathophysiologic mechanisms underlying the troponin elevations are not always clear, abnormal troponin consistently identifies stroke patients at higher risk of death or major disability [7][8][9][10][11][12][13][14] . In addition, several recent analyses using high-sensitivity troponin assays have suggested that dynamic changes in troponin after hospital admission are critical to identifying patients at highest risk of adverse cardiac and neurologic outcomes [15,16] .…”

Section: Introductionmentioning

confidence: 99%

Ischemic Stroke with Troponin Elevation: Patient Characteristics, Resource Utilization, and In-Hospital Outcomes

et al. 2016

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Background: Among patients hospitalized for acute ischemic stroke, abnormal serum troponins are associated with higher risk of short-term mortality. However, most findings have been reported from European hospitals. Whether troponin elevation after stroke is independently associated with death among a more heterogeneous US population remains unclear. Furthermore, only a few studies have evaluated the association between the magnitude of troponin elevation and subsequent mortality, patterns of dynamic troponin changes over time, or whether troponin elevation is related to specific causes of death. Methods: Using data collected in the American Heart Association's ‘Get With The Guidelines' stroke registry between 2008 and 2012 at a tertiary care US hospital, we used logistic regression to evaluate the independent relationship between troponin elevation and mortality after adjusting for demographic and clinical characteristics. We then assessed whether the magnitude of troponin elevation was related to in-hospital mortality by calculating mortality rates according to tertiles of peak troponin levels. Dynamic troponin changes over time were evaluated as well. To better understand whether troponin elevation identified patients most likely to die due to a specific cause of death, investigators blinded from troponin values reviewed all in-hospital deaths, and the association between troponin elevation and mortality was evaluated among patients with cardiac, neurologic, or other causes of death. Results: Of 1,145 ischemic stroke patients, 199 (17%) had elevated troponin levels. Troponin-positive patients had more cardiovascular risk factors, more intensive medical therapy, and greater use of cardiac procedures. These individuals had higher in-hospital mortality rates than troponin-negative patients (27 vs. 8%, p < 0.001), and this association persisted after adjustment for 13 clinical and management variables (OR 4.28, 95% CI 2.40-7.63). Any troponin elevation was associated with higher mortality, even at very low peak troponin levels (mortality rates 24-29% across tertiles of troponin). Patients with persistently rising troponin levels had fewer anticoagulant and antiatherosclerotic therapies, with markedly worse outcomes. Furthermore, troponin-positive patients had higher rates of all categories of death: neurologic (17 vs. 7%), cardiac (5 vs. <1%), and other causes of death (5 vs. <1%; p < 0.001 for all comparisons). Conclusions: Ischemic stroke patients with abnormal troponin levels are at higher risk of in-hospital death, even after accounting for demographic and clinical characteristics, and any degree of troponin elevation identifies this higher level of risk. Troponins that continue to rise during the hospitalization identify stroke patients at markedly higher risk of mortality, and both neurologic and non-neurologically mediated mortality rates are higher when troponin is elevated.

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Elevated troponin I levels on admission predict long-term mortality in patients with acute cerebral infarction following thrombolysis

et al. 2022

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Background/objective Cardiac diseases are frequently accompanied by elevated levels of biomarkers, among which, troponin is commonly investigated. The levels of plasma cardiac troponin I (cTnI), which has been shown to predict short-term mortality, are elevated in patients with acute cerebral infarction (ACI). However, few studies have assessed the association between cTnI concentration and long-term mortality in patients with ACI following thrombolysis. Methods Patients with ACI admitted between January 1, 2014, and December 31, 2016, were registered. Data on demographics and outcomes with elevated cTnI levels were also collected. Results A total of 145 patients with ACI were recruited; 97 (66%), 30 (20%), and 18 (12%) patients had cTnI concentrations < 0.030 (group 1), 0.030–0.10 (group 2), and > 0.10 μg/L (group 3), respectively. cTnI elevation was associated with older age, atrial fibrillation, congestive heart failure, renal insufficiency, coronary artery disease, stroke severity (National Institutes of Health Stroke Scale score), and prior smoking history at admission. After adjusting for comorbidities and severity at 3 months after ACI, cTnI elevation on admission was significantly associated with ascending 5-year mortality (hazard ratio, 1.80; 95% confidence interval, 1.22–2.65). Conclusions Even after adjusting for several possible confounders, cTnI elevation in patients with ACI treated with rt-PA was associated with a 1.80-fold increased risk of 5-year mortality.

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The Significance of Troponin Elevation for the Clinical Course and Outcome of First-Ever Ischaemic Stroke

Cited by 18 publications

References 28 publications

Impact of troponin I on outcome of ischemic stroke patients

Impact of troponin I on outcome of ischemic stroke patients

Ischemic Stroke with Troponin Elevation: Patient Characteristics, Resource Utilization, and In-Hospital Outcomes

Elevated troponin I levels on admission predict long-term mortality in patients with acute cerebral infarction following thrombolysis

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