Document Detail


Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke.
MedLine Citation:
PMID:  15607999     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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) in-hospital 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 "in-hospital 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.
Authors:
E Di Angelantonio; M Fiorelli; D Toni; M L Sacchetti; S Lorenzano; A Falcou; M V Ciarla; M Suppa; L Bonanni; G Bertazzoni; F Aguglia; C Argentino
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurology, neurosurgery, and psychiatry     Volume:  76     ISSN:  0022-3050     ISO Abbreviation:  J. Neurol. Neurosurg. Psychiatr.     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2004-12-20     Completed Date:  2005-02-08     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  2985191R     Medline TA:  J Neurol Neurosurg Psychiatry     Country:  England    
Other Details:
Languages:  eng     Pagination:  76-81     Citation Subset:  IM    
Affiliation:
Department of Neurological Sciences, University of Rome La Sapienza, Viale dell'Università 30, 00185 Rome, Italy.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Aged, 80 and over
Biological Markers / blood
Brain Ischemia / blood*,  complications
Creatine Kinase / blood
Creatine Kinase, MB Form
Electrocardiography
Female
Follow-Up Studies
Heart Diseases / diagnosis,  etiology
Humans
Isoenzymes / blood
Male
Middle Aged
Myoglobin / blood
Patient Admission
Predictive Value of Tests
Prognosis
Prospective Studies
Stroke / blood*,  etiology
Troponin I / blood*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Isoenzymes; 0/Myoglobin; 0/Troponin I; EC 2.7.3.2/Creatine Kinase; EC 2.7.3.2/Creatine Kinase, MB Form
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