Alkhachroum Ayham M, Miller Benjamin, Chami Tarek, Tatsuoka Curtis, Sila Cathy
Columbia University Medical Center, New York, NY, United States.
University of Minnesota, Minneapolis, MN, United States.
J Clin Neurosci. 2019 Jun;64:83-88. doi: 10.1016/j.jocn.2019.04.005. Epub 2019 Apr 20.
Troponin elevations due to Type II myocardial infarction (T2MI) are associated with hemorrhagic and ischemic strokes but there is little data on stroke severity, troponin elevation and outcome. We studied 1655 patients from a tertiary medical center between 1/2013-4/2015 using multivariate regression analysis for demographics, vascular risk factors, admission stroke severity, laboratory tests, echocardiogram results and discharge disposition. Troponin levels were classified as normal <0.04 ng/ml and high >0.04 ng/ml (critical if >0.5 ng/ml). A T2MI was diagnosed by a trending troponin elevation; patients with type I MI, patients with subdural and epidural hematoma, or hemorrhagic metastatic disease and patients younger than 18 years old were excluded. We had 818 patients with ischemic stroke, 306 with intracerebral hemorrhage (ICH) and 169 with subarachnoid hemorrhage (SAH). Troponin was elevated (>0.04 ng/ml) in 24.1% of ischemic stroke patients, 27.1% in the ICH group, and in 39% of SAH patients. High initial and peak troponin levels were associated with higher National Institutes of Health Stroke Scale (NIHSS) in patients with ischemic stroke (OR 1.04; CI 95%, 1.02-1.07, p = .001) and (OR 1.05; CI 95%, 1.03-1.07, p < .001). In ICH patients, higher initial and peak troponin levels were not associated with worse ICH scores (OR 1.21; CI 95%, 0.66-2.22, p = .53) and (OR 1.36; CI 95%, 0.77-2.41, p = .29). In SAH patients, higher initial and peak troponin levels was associated with higher Hunt and Hess scores (OR 4.2; CI 95%, 1.6-11.4, p = .005) and (OR 3.14; CI 95%, 1.5-6.5, p = .002). In patients with high troponin levels mortality was 14.7% in ischemic stroke patients, 31.3% in our ICH patients, and 43.8% in our SAH. After adjusting for demographics and clinical risk factors, only high troponin ischemic stroke patients were associated with higher mortality (OR 6.16; CI95%, 2.46-15.4, p < .001), and worse discharge disposition (OR 2.3; CI 95%, 1.19-4.45, p = .01). High troponin levels were not associated with change of outcomes in patients with SAH and ICH after adjusting for demographics and clinical risk factors. Elevated troponin due to T2MI is common in patients with ischemic strokes, ICH, and SAH. It is significantly associated with stroke severity, poor discharge disposition, and high mortality. Troponin levels should be considered on admission for acute strokes.
因II型心肌梗死（T2MI）导致的肌钙蛋白升高与出血性和缺血性中风相关，但关于中风严重程度、肌钙蛋白升高和预后的数据很少。我们对2013年1月至2015年4月期间来自一家三级医疗中心的1655例患者进行了研究，使用多变量回归分析来分析人口统计学、血管危险因素、入院时中风严重程度、实验室检查、超声心动图结果和出院处置情况。肌钙蛋白水平分为正常<0.04 ng/ml和高>0.04 ng/ml（如果>0.5 ng/ml则为危急值）。通过肌钙蛋白水平呈上升趋势来诊断T2MI；排除I型心肌梗死患者、硬膜下和硬膜外血肿患者、出血性转移性疾病患者以及年龄小于18岁的患者。我们有818例缺血性中风患者、306例脑出血（ICH）患者和169例蛛网膜下腔出血（SAH）患者。缺血性中风患者中24.1%的肌钙蛋白升高（>0.04 ng/ml），ICH组为27.1%，SAH患者为39%。缺血性中风患者中，肌钙蛋白初始水平和峰值较高与较高的美国国立卫生研究院卒中量表（NIHSS）评分相关（比值比[OR] 1.04；95%置信区间[CI]，1.02 - 1.07，p = 0.001）以及（OR 1.05；CI 95%，1.03 - 1.07，p < 0.001）。在ICH患者中，较高的肌钙蛋白初始水平和峰值与较差的ICH评分无关（OR 1.21；CI 95%，0.66 - 2.22，p = 0.53）以及（OR 1.36；CI 95%，0.77 - 2.41，p = 0.29）。在SAH患者中，较高的肌钙蛋白初始水平和峰值与较高的Hunt和Hess评分相关（OR 4.2；CI 95%，1.6 - 11.4，p = 0.005）以及（OR 3.14；CI 95%，1.5 - 6.5，p = 0.002）。肌钙蛋白水平高的患者中，缺血性中风患者的死亡率为14.7%，我们的ICH患者为31.3%，我们的SAH患者为43.8%。在调整了人口统计学和临床危险因素后，只有肌钙蛋白水平高的缺血性中风患者与较高的死亡率相关（OR 6.16；CI95%，2.46 - 15.4，p < 0.001），以及较差的出院处置情况（OR 2.3；CI 95%，1.19 - 4.45，p = 0.01）。在调整了人口统计学和临床危险因素后，SAH和ICH患者中肌钙蛋白水平高与预后变化无关。因T2MI导致的肌钙蛋白升高在缺血性中风、ICH和SAH患者中很常见。它与中风严重程度、不良出院处置和高死亡率显著相关。急性中风入院时应考虑检测肌钙蛋白水平。
