Prognostic Value of Cardiac Troponin I in Acute Ischemic Stroke Patients Treated with Thrombolytic Therapy: A Multicenter Retrospective Cohort Study.
Kaitlyn Pixley1, Andrea Loggini2, Heather Von Hagn2, Laura Boada Robayo1, Ayesha Sajid3, Trace Lawson3, Jonatan Hornik2, Amber Schwertman4, Karam Dallow2, Alejandro Hornik2, Camila Bonin Pinto5, Faddi Saleh Velez1
1Brain Stimulation and Neurorehabilitation Laboratory, Department of Neurology. University of Oklahoma Health Sciences Center, Oklahoma City. OK. USA., 2Brain and Spine Institute, Southern Illinois Healthcare, Carbondale, IL./Southern Illinois University School of Medicine, Carbondale, IL., 3The University of Oklahoma College of Medicine, 4Southern Illinois University School of Medicine, Carbondale, IL., 5Brain stimulation & Neurorehabilitation Laboratory, Department of Neurosurgery, University of Oklahoma
Background:
Cardiac troponin is a well-established diagnostic and prognostic marker in coronary heart disease. We investigated its prognostic value in acute ischemic stroke (AIS) patients treated with thrombolytic therapy.
Design/Methods:
We conducted a multicenter retrospective observational study of AIS patients treated with thrombolytics at The University of Oklahoma and Southern Illinois Healthcare (2017-2024). Demographics, clinical, laboratory, and radiographic data were collected. Cardiac troponin I (cTnI) on admission and subsequent values during the same hospitalization were reviewed. Patients were divided by admission cTnI levels. Outcomes included symptomatic intracranial hemorrhage (sICH), in-hospital mortality, and mRS at 30 days (good outcome was defined as mRS ≤ 2). Multivariable logistic regression was used to evaluate the association between cTnI and predetermined outcomes. Statistical significance was set at p<0.05.
Results:
Of 496 patients included in the study, 143 (29%) had elevated cTnI. Compared to patients with normal cTnI, those with elevated levels were older (75 [64-84] vs. 65 [54-76] years), had higher rate of hypertension (83% vs. 71%), diabetes (37% vs. 27%), cardiac diseases (51% vs. 29%), and higher initial NIHSS (11 [5-17] vs. 7 [4-13]). After adjustment for age, preexistent cardiac disease, baseline mRS, and NIHSS, logistic regression revealed that elevated cTnI remained independently associated with development of sICH (OR: 3.667, 95%CI: 1.105-12.161, p=0.034), higher odds of in-hospital mortality (OR: 2.277, 95%CI: 1.052-4.925, p=0.037), and lower likelihood of good short-term functional outcome (OR: 0.425, 95%CI: 0.26-0.693, p<0.001). Normalization of cardiac enzymes did not translate into improvement in survival (p>0.05).
Conclusions:
In our study, elevation of cardiac enzymes at presentation was an independent factor associated with an increased risk of sICH and an unmodifiable predictor of worse short-term outcomes in AIS patients treated with thrombolytic therapy.
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