HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Di Angelantonio, E Articles by Argentino, C Search for Related Content PubMed PubMed Citation Articles by Di Angelantonio, E Articles by Argentino, C Related Collections Ischemic heart disease Stroke

Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke

¹ Department of Internal Medicine, University of Rome "La Sapienza", Rome, Italy
² Department of Neurological Sciences, University of Rome "La Sapienza", Rome, Italy
³ Department of Emergency Medicine, University of Rome "La Sapienza", Rome, Italy
⁴ Departments of Cellular Biotechnology and Hematology, University of Rome, Rome, Italy

Correspondence to:
Correspondence to:
Dr M Fiorelli
Department of Neurological Sciences, University of Rome "La Sapienza", Viale dell’Università 30, 00185 Rome, Italy; marco.fiorelli{at}uniroma1.it

Objectives: Successful prediction of cardiac complications early in the course of acute ischaemic stroke could have an impact on the clinical management. Markers of myocardial injury on admission deserve investigation as potential predictors of poor outcome from stroke.

Methods: We prospectively investigated 330 consecutive patients with acute ischaemic stroke admitted to our emergency department based stroke unit. We analysed the association of baseline levels of cardiac troponin I (cTnI) with (a) all-cause mortality over a six month follow up, and (b) inhospital death or major non-fatal cardiac event (angina, myocardial infarction, or heart failure).

Results: cTnI levels on admission were normal (lower than 0.10 ng/ml) in 277 patients (83.9%), low positive (0.10–0.39 ng/ml) in 35 (10.6%), and high positive (0.40 ng/ml or higher) in 18 (5.5%). Six month survival decreased significantly across the three groups (p<0.0001, log rank test for trend). On multivariate analysis, cTnI level was an independent predictor of mortality (low positive cTnI, hazard ratio (HR) 2.14; 95% CI 1.13 to 4.05; p = 0.01; and high positive cTnI, HR 2.47; 95% CI 1.22 to 5.02; p = 0.01), together with age and stroke severity. cTnI also predicted a higher risk of the combined endpoint "inhospital death or non-fatal cardiac event". Neither the adjustment for other potential confounders nor the adjustment for ECG changes and levels of CK-MB and myoglobin on admission altered these results.

Conclusions: cTnI positivity on admission is an independent prognostic predictor in acute ischaemic stroke. Whether further evaluation and treatment of cTnI positive patients can reduce cardiac morbidity and mortality should be the focus of future research.

Abbreviations: cTnI, cardiac troponin I; cTnT, cardiac troponin T; MI, myocardial infarction; NIHSS, National Institutes of Health Stroke Scale; SU, stroke unit

Keywords: troponin I; ischaemic stroke; electrocardiography

This article has been cited by other articles:

				M. N. Diringer, B. E. Skolnick, S. A. Mayer, T. Steiner, S. M. Davis, N. C. Brun, and J. P. Broderick Risk of Thromboembolic Events in Controlled Trials of rFVIIa in Spontaneous Intracerebral Hemorrhage Stroke, March 1, 2008; 39(3): 850 - 856. [Abstract] [Full Text] [PDF]

				NACB WRITING GROUP MEMBERS, A. H.B. Wu, A. S. Jaffe, F. S. Apple, R. L. Jesse, G. L. Francis, D. A. Morrow, L. K. Newby, J. Ravkilde, W.H. W. Tang, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Use of Cardiac Troponin and B-Type Natriuretic Peptide or N-Terminal proB-Type Natriuretic Peptide for Etiologies Other than Acute Coronary Syndromes and Heart Failure Clin. Chem., December 1, 2007; 53(12): 2086 - 2096. [Abstract] [Full Text] [PDF]

				A. Hays and M. N. Diringer Elevated troponin levels are associated with higher mortality following intracerebral hemorrhage Neurology, May 9, 2006; 66(9): 1330 - 1334. [Abstract] [Full Text] [PDF]