Ahn Sung-Ho, Lee Ji-Sung, Yun Mi-Sook, Han Jung-Hee, Kim Soo-Young, Kim Young-Hak, Lee Sang-Hyun, Park Min-Gyu, Park Kyung-Pil, Kang Dong-Wha, Kim Jong S, Kwon Sun U
Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea.
Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Stroke. 2023 Jan;25(1):141-150. doi: 10.5853/jos.2022.02012. Epub 2023 Jan 31.
We investigated the impact of comorbidity burden on troponin elevation, with separate consideration of neurological conditions, in patients with acute ischemic stroke (AIS).
This prospective, observational cohort study consecutively enrolled patients with AIS for 2 years. Serum cardiac troponin I was repeatedly measured, and disease-related biomarkers were collected for diagnosis of preassigned comorbidities, including atrial fibrillation (AF), ischemic heart disease (IHD), myocardial hypertrophy (MH), heart failure (HF), renal insufficiency (RI), and active cancer. The severity of neurological deficits and insular cortical ischemic lesions were assessed as neurological conditions. Adjusted associations between these factors and troponin elevation were determined using a multivariate ordinal logistic regression model and area under the receiver operating characteristic curve (AUC). Cox proportional hazards model was used to determine the prognostic significance of comorbidity beyond neurological conditions.
Among 1,092 patients (66.5±12.4 years, 63.3% male), 145 (13.3%) and 335 (30.7%) had elevated (≥0.040 ng/mL) and minimally-elevated (0.040-0.010 ng/mL) troponin, respectively. In the adjusted analysis, AF, MH, HF, RI, active cancer, and neurological deficits were associated with troponin elevation. The multivariate model with six comorbidities and two neurological conditions exhibited an AUC of 0.729 (95% confidence interval [CI], 0.698-0.759). In Cox regression, AF, IHD, and HF were associated with adverse cardio-cerebrovascular events, whereas HF and active cancer were associated with mortality.
Troponin elevation in patients with AIS can be explained by the burden of comorbidities in combination with neurological status, which explains the prognostic significance of troponin assay.
我们研究了合并症负担对急性缺血性卒中（AIS）患者肌钙蛋白升高的影响，并分别考虑了神经系统疾病。
这项前瞻性观察性队列研究连续纳入AIS患者2年。反复测量血清心肌肌钙蛋白I，并收集疾病相关生物标志物以诊断预先指定的合并症，包括心房颤动（AF）、缺血性心脏病（IHD）、心肌肥厚（MH）、心力衰竭（HF）、肾功能不全（RI）和活动性癌症。评估神经功能缺损的严重程度和岛叶皮质缺血性病变作为神经系统疾病。使用多变量有序逻辑回归模型和受试者操作特征曲线下面积（AUC）确定这些因素与肌钙蛋白升高之间的校正关联。使用Cox比例风险模型确定合并症超出神经系统疾病的预后意义。
在1092例患者（66.5±12.4岁，63.3%为男性）中，分别有145例（13.3%）和335例（30.7%）肌钙蛋白升高（≥0.040 ng/mL）和轻度升高（0.040 - 0.010 ng/mL）。在校正分析中，AF、MH、HF、RI、活动性癌症和神经功能缺损与肌钙蛋白升高有关。包含六种合并症和两种神经系统疾病的多变量模型的AUC为0.729（95%置信区间[CI]，0.698 - 0.759）。在Cox回归中，AF、IHD和HF与不良心脑血管事件有关，而HF和活动性癌症与死亡率有关。
AIS患者的肌钙蛋白升高可由合并症负担与神经状态共同解释，这解释了肌钙蛋白检测的预后意义。
