High-sensitivity troponin assay improves prediction of cardiovascular risk in patients with cerebral ischaemia
- Raoul Stahrenberg1,
- Cord-Friedrich Niehaus1,
- Frank Edelmann1,
- Meinhard Mende2,
- Janin Wohlfahrt3,
- Katrin Wasser3,
- Joachim Seegers1,
- Gerd Hasenfuß1,
- Klaus Gröschel3,4,
- Rolf Wachter1
- 1Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
- 2Centre for Clinical Trials, University of Leipzig, Leipzig, Germany
- 3Department of Neurology, University of Göttingen, Göttingen, Germany
- 4Department of Neurology, University of Mainz, Mainz, Germany
- Correspondence to Dr Raoul Stahrenberg, Department of Cardiology and Pneumology, University of Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany;
- Received 1 June 2012
- Revised 10 December 2012
- Accepted 18 December 2012
- Published Online First 25 January 2013
Background and purpose Clinical scores are recommended for predicting cardiovascular risk in patients with cerebral ischaemia to inform secondary prevention. Blood biomarkers may improve prediction beyond clinical scores.
Methods Within the observational Find-AF trial (ISRCTN46104198), 197 patients >18 years of age with cerebral ischaemia and without atrial fibrillation had blood sampled at baseline. The predictive value of five biomarkers for a combined vascular endpoint (acute coronary syndrome, stroke, cardiovascular death) and all-cause mortality was determined, alone and in addition to the Essen Stroke Risk Score (ESRS), Stroke Prognostic Instrument 2 (SPI-2) and National Institutes of Health Stroke Scale (NIH-SS).
Results There were 23 vascular events (11.7%) and 13 deaths (6.6%) to 1 year follow-up. In multivariate analyses of all markers, only high-sensitivity troponin T (hsTropT) remained independently predictive for vascular events (p=0.045) and all-cause mortality (p=0.004). hsTropT was higher in patients with a vascular event (median 12.7 ng/ml vs 5.1 ng/ml), and patients with hsTropT above the median of 6.15 ng/ml had vascular events more frequently (HR 3.86, p=0.008). For prediction of vascular events as well as all-cause mortality, hsTropT significantly improved multivariate Cox regression models with ESRS, SPI-2 or NIH-SS. The c-statistic increased non-significantly from 0.695 (ESRS) or 0.710 (hsTropT) to 0.747 (ESRS+hsTropT) and from 0.699 (SPI-2) to 0.763 (SPI-2+hsTropT). No patient with a low-risk ESRS and an hsTropT below the median had a vascular event or died.
Conclusions hsTropT predicts vascular events and all-cause mortality in patients with acute cerebral ischaemia and improves prediction beyond established clinical scores.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode