Author + information
- Omar Batal,
- Nadeem Kolia,
- Bhavna Balaney,
- Gavin Hickey,
- Zeina Dardari,
- Hunter Champion,
- Vivek Reddy,
- Tudor Jovin,
- Maxim Hammer and
- Mark Schmidhofer
Acute ischemic stroke is a cause of troponin elevation which is often attributed to demand, type 2 myocardial infarction (MI). The incidence of spontaneous, type 1 MI is unknown.
We reviewed our prospective hospital registry of acute ischemic stroke (2009–2010). All patients had ≥3 troponin I (TnI) measures. Patients with elevated TnI were classified as group 1 if they had high risk features: ST elevations, ischemic ST/T waves, new Q waves, left bundle branch block on electrocardiogram, chest pain, new segmental wall motion abnormality or TnI ≥ 2 ug/L. Group 2 had the remaining elevated TnI, likely type 2 MI patients. Primary outcome was in–hospital mortality or discharge to hospice.
Patients (N=1761) aged 68 ± 15 y, 50 % female were hospitalized for 5 ± 6 days; 9 % died in–hospital and 4 % were discharged to hospice. TnI in group 1 (N=81) was 10.5 ± 15.1 vs 0.3 ± 0.3 ug/L in group 2 (N=228). Primary outcome was higher in group 1 vs. 2 (37% vs 25%, p=0.03). Group 1 had lower ejection fraction (47 ± 17 vs 52 ± 14 %, p=0.04) and were more likely to undergo coronary angiography (24% vs 8%, p= 0.0004). History of coronary artery disease, kidney disease, or heart failure were not significantly different. Group 1 and 2 had worse outcome than TnI negative patients (figure), and this grouping was prognostic even with adjusting for age and NIH Stroke Scale score (p<0.0001).
Troponin I elevation consistent with type 1 and type 2 MI are common in acute ischemic stroke and associated with worse outcomes.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.–10:45 a.m.
Session Title: Atherosclerosis, Inflammation, Biomarkers and Outcomes: What's New?
Abstract Category: 35. Vascular Medicine: Non Coronary Arterial Disease
Presentation Number: 1124–160
- 2013 American College of Cardiology Foundation