Article Text

Download PDFPDF
Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke
  1. E Di Angelantonio1,
  2. M Fiorelli2,
  3. D Toni2,
  4. M L Sacchetti2,
  5. S Lorenzano2,
  6. A Falcou2,
  7. M V Ciarla4,
  8. M Suppa3,
  9. L Bonanni3,
  10. G Bertazzoni3,
  11. F Aguglia3,
  12. C Argentino2
  1. 1Department of Internal Medicine, University of Rome “La Sapienza”, Rome, Italy
  2. 2Department of Neurological Sciences, University of Rome “La Sapienza”, Rome, Italy
  3. 3Department of Emergency Medicine, University of Rome “La Sapienza”, Rome, Italy
  4. 4Departments of Cellular Biotechnology and Hematology, University of Rome, Rome, Italy
  1. Correspondence to:
 Dr M Fiorelli
 Department of Neurological Sciences, University of Rome “La Sapienza”, Viale dell’Università 30, 00185 Rome, Italy;


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.

  • cTnI, cardiac troponin I
  • cTnT, cardiac troponin T
  • MI, myocardial infarction
  • NIHSS, National Institutes of Health Stroke Scale
  • SU, stroke unit
  • troponin I
  • ischaemic stroke
  • electrocardiography

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • This work was supported in part by a grant of the Italian Ministry of Health (ICS 030.6/RF00-49).

  • Competing interests: none declared