Prognostic Significance of Troponin Elevation for Long-Term Mortality after Ischemic Stroke
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Background and Purpose Troponin, a marker of myocardial injury, frequently increases and is related with poor outcome in ischemic stroke patients. However, the long-term outcome of this elevation remains uncertain. We, therefore, investigated the prognostic significance of troponin elevation for long-term mortality, and explored factors affecting troponin elevation after ischemic stroke. Methods We retrospectively analyzed the medical data of stroke patients who were admitted within 24 hours of symptom onset and underwent a serum cardiac troponin I test at admission during a five-year period. Information on mortality as the outcome was obtained from the National Death Certificate system. Results A total of 1,692 patients were eligible for inclusion with 33 months of median follow-up. Troponin elevation that exceeded the 99th percentile (>0.04 ng/mL) of values was detected in 166 patients (9.8%). After adjusting for baseline characteristics, troponin elevation was associated with previous ischemic heart disease and congestive heart failure, comorbid atrial fibrillation and active cancer, and increased National Institutes of Health Stroke Scale score. Patients with troponin elevation had a high risk of overall death (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.40–2.40), including stroke-related (HR 1.71, 95% CI 1.14–2.55), cardiac-related (HR 3.17, 95% CI 1.49–6.74), and cancer-related (HR 1.98, 95% CI 1.14–3.45) death than those without troponin elevation. Conclusions Troponin elevation in the acute stage of ischemic stroke was associated with long-term mortality, mainly due to increased stroke- and cancer-related death in the first year and cardiacrelated death in the later period.
Abstract
Background and Purpose Troponin, a marker of myocardial injury, frequently increases and is related with poor outcome in ischemic stroke patients. However, the long-term outcome of this elevation remains uncertain. We, therefore, investigated the prognostic significance of troponin elevation for long-term mortality, and explored factors affecting troponin elevation after ischemic stroke. Methods We retrospectively analyzed the medical data of stroke patients who were admitted within 24 hours of symptom onset and underwent a serum cardiac troponin I test at admission during a five-year period. Information on mortality as the outcome was obtained from the National Death Certificate system. Results A total of 1,692 patients were eligible for inclusion with 33 months of median follow-up. Troponin elevation that exceeded the 99th percentile (>0.04 ng/mL) of values was detected in 166 patients (9.8%). After adjusting for baseline characteristics, troponin elevation was associated with previous ischemic heart disease and congestive heart failure, comorbid atrial fibrillation and active cancer, and increased National Institutes of Health Stroke Scale score. Patients with troponin elevation had a high risk of overall death (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.40–2.40), including stroke-related (HR 1.71, 95% CI 1.14–2.55), cardiac-related (HR 3.17, 95% CI 1.49–6.74), and cancer-related (HR 1.98, 95% CI 1.14–3.45) death than those without troponin elevation. Conclusions Troponin elevation in the acute stage of ischemic stroke was associated with long-term mortality, mainly due to increased stroke- and cancer-related death in the first year and cardiacrelated death in the later period.
참고문헌 (36)
- Thygesen K, "Third universal definition of myocardial infarction", J Am Coll Cardiol, 60, pp.1581~1598 (2012)
- Popp RL, "Troponin: messenger or actor?", J Am Coll Cardiol, 61, pp.611~614 (2013)
- Fure B, "Electrocardiographic and troponin T changes in acute ischaemic stroke", J Intern Med, 259, pp.592~597 (2006)
- Jensen JK, "Frequency and significance of troponin T elevation in acute ischemic stroke", Am J Cardiol, 99, pp.108~112 (2007)
- Kerr G, "Elevated troponin after stroke: a systematic review", Cerebrovasc Dis, 28, pp.220~226 (2009)
- Di Angelantonio E, "Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke", J Neurol Neurosurg Psychiatry, 76, pp.76~81 (2005)
- Scheitz JF, "Frequency, determinants and outcome of elevated troponin in acute ischemic stroke patients", Int J Cardiol, 157, pp.239~242 (2012)
- Palma JA, "Neural control of the heart: recent concepts and clinical correlations", Neurology, 83, pp.261~271 (2014)
- Thygesen K, "How to use high-sensitivity cardiac troponins in acute cardiac care", Eur Heart J, 33, pp.2252~2257 (2012)
- Adams HP Jr, "Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association", American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists, 2007, pp.115, e478~e534
- Brott T, "Measurements of acute cerebral infarction: a clinical examination scale", Stroke, 20, pp.864~870 (1989)
- Keun-Sik Hong, "Update of the Korean Clinical Practice Guidelines for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke", 대한뇌졸중학회지, 18(1), pp.102~113 (2016), 대한뇌졸중학회
- Adams HP Jr, "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment", Stroke, 24, pp.35~41 (1993)
- Prineas RJ, "The Minnesota Code Manual of Electrocardiographic Findings", pp.328~ (2010), Springer
- Lang RM, "Recommendations for chamber quantification:a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology", J Am Soc Echocardiogr, 18, pp.1440~1463 (2005)
- de Simone G, "Evaluation of concentric left ventricular geometry in humans: evidence for age-related systematic underestimation", Hypertension, 45, pp.64~68 (2005)
- World Health Organization, "International statistical classification of diseases and related health problems" (1992), WHO
- Robins JM, "Marginal structural models and causal inference in epidemiology", Epidemiology, 11, pp.550~560 (2000)
- Hernán MA, "Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men", Epidemiology, 11, pp.561~570 (2000)
- Brookhart MA, "Propensity score methods for confounding control in nonexperimental research", Circ Cardiovasc Qual Outcomes, 6, pp.604~611 (2013)
- Thygesen K, "Universal definition of myocardial infarction", J Am Coll Cardiol, 50, pp.2173~2195 (2007)
- Keller T, "Defining a reference population to determine the 99th percentile of a contemporary sensitive cardiac troponin I assay", Int J Cardiol, 167, pp.1423~1429 (2013)
- Vernino S, "Cause-specific mortality after first cerebral infarction:a population-based study", Stroke, 34, pp.1828~1832 (2003)
- Lamassa M, "Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry (The European Community Stroke Project)", Stroke, 32, pp.392~398 (2001)
- 송화석, "Cardiac Troponin T Elevation After Stroke: Relationships Between Elevated Serum Troponin T, Stroke Location, and Prognosis", Journal of Clinical Neurology, 4(2), pp.75~83 (2008), 대한신경과학회
- van den Bos EJ, "Minor elevations in troponin I are associated with mortality and adverse cardiac events in patients with atrial fibrillation", Eur Heart J, 32, pp.611~617 (2011)
- Fang MC, "Long-term survival after ischemic stroke in patients with atrial fibrillation", Neurology, 82, pp.1033~1037 (2014)
- Touzé E, "Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis", Stroke, 36, pp.2748~2755 (2005)
- Hardie K, "Ten-year survival after first-ever stroke in the perth community stroke study", Stroke, 34, pp.1842~1846 (2003)
- Hardie K, "Trends in five-year survival and risk of recurrent stroke after first-ever stroke in the Perth Community Stroke Study", Cerebrovasc Dis, 19, pp.179~185 (2005)
- Brønnum-Hansen H, "Long-term survival and causes of death after stroke", Stroke, 32, pp.2131~2136 (2001)
- Caine GJ, "The hypercoagulable state of malignancy: pathogenesis and current debate", Neoplasia, 4, pp.465~473 (2002)
- Cardinale D, "Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy", Circulation, 109, pp.2749~2754 (2004)
- Cestari DM, "Stroke in patients with cancer: incidence and etiology", Neurology, 62, pp.2025~2030 (2004)
- Mahajan VS, "How to interpret elevated cardiac troponin levels", Circulation, 124, pp.2350~2354 (2011)
- Ahn SH, "Cardiac vulnerability to cerebrogenic stress as a possible cause of troponin elevation in stroke", J Am Heart Assoc, 5, pp.e004135~ (2016)