• Int. J. Cardiol. · Dec 2014

    Prognostic relevance of cardiac troponin T levels and their dynamic changes measured with a high-sensitivity assay in acute ischaemic stroke: analyses from the TRELAS cohort.

    • Jan F Scheitz, Hans-C Mochmann, Hebun Erdur, Serdar Tütüncü, Karl Georg Haeusler, Ulrike Grittner, Ulrich Laufs, Matthias Endres, and Christian H Nolte.
    • Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Excellence Cluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany. Electronic address: jan-friedrich.scheitz@charite.de.
    • Int. J. Cardiol. 2014 Dec 20; 177 (3): 886-93.

    Background/ObjectivesTo assess the prognostic relevance of cardiac troponin T (cTnT) values and their serial changes as measured with a high-sensitivity assay in acute ischaemic stroke.Methods And ResultsIn total, 1016 consecutive acute ischaemic stroke patients were registered prospectively within a two-year period. High-sensitivity cTnT was quantitated on admission and the following day. Patients were stratified into three groups: below the 99 th percentile of a healthy reference population (< 14 ng/l; n = 409), moderately elevated cTnT (below the median of remaining patients, 14-30 ng/l; n=299) and high cTnT (> 30 ng/l; n = 308). Outcome measures were unfavourable outcome (modified Rankin Scale ≥ 2 at hospital discharge, n=604) and in-hospital mortality (n = 36). Peak cTnT levels were significantly associated with unfavourable outcome (adjusted odds ratios versus reference for moderately elevated cTnT 1.7, 95% confidence interval [CI] 1.1-2.7 and for high cTnT 3.1, 95% CI 1.8-5.6). The optimal cut-off for determining unfavourable outcome proved to be 16 ng/l. Adding this cut-off to clinical variables led to a significant improvement of c-statistics (0.851 versus 0.838, p=0.02). Dynamic changes (δ ≥ 50%) of cTnT were detected in 137 patients (13%). Multiple Cox regression analysis showed an independent association of dynamic changes in cTnT with in-hospital mortality (hazard ratio 2.3, 95% CI 1.1-4.7). The model-fitting (p<0.001) and c-statistics (0.889 versus 0.863, p = 0.08) improved most after dynamic change in cTnT had been added to a regression model which included clinical variables alone.ConclusionsOur study adds novel findings relevant for interpretation of highly sensitive cTnT assays in acute ischaemic stroke: a) Myocardial injury is detectable in more than half of patients; b) even moderately elevated cTnT is associated with unfavourable outcome (optimal cut-off 16 ng/l); and c) dynamic changes in cTnT indicate an increased risk of in-hospital death.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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