Willeit Karin, Boehme Christian, Toell Thomas, Tschiderer Lena, Seekircher Lisa, Mayer-Suess Lukas, Komarek Silvia, Lang Wilfried, Griesmacher Andrea, Knoflach Michael, Willeit Johann, Kiechl Stefan, Willeit Peter
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria.
JACC Adv. 2024 Jun 4;3(7):101022. doi: 10.1016/j.jacadv.2024.101022. eCollection 2024 Jul.
High-sensitivity cardiac troponin T (hs-cTnT) is associated with cardiovascular disease (CVD) risk in general and various high-risk populations.
The purpose of this study was to precisely characterize the association of hs-cTnT with CVD risk in patients following acute ischemic stroke or transient ischemic attack.
We conducted post hoc analyses of data from the STROKE-CARD trial (NCT02156778), a pragmatic randomized controlled trial of a disease management program in patients with acute ischemic stroke or transient ischemic attack (ABCD score ≥3). We measured hs-cTnT on admission (Roche Elecsys, detection limit 5 ng/L) and quantified HRs for a composite CVD outcome (ie, stroke, myocardial infarction, CVD death) adjusted for age, sex, prior coronary heart disease, prior heart failure, diabetes, smoking, systolic blood pressure, and low- and high-density-lipoprotein cholesterol.
Among 1,687 patients (mean age, 69.3 ± 13.7 years; 40.7% female), hs-cTnT was detectable in 80.7%. Median hs-cTnT was 10 ng/L (IQR: 6-18 ng/L). Over a median follow-up of 12.1 months, 110 patients had a CVD event. The association of hs-cTnT level with CVD risk was of log-linear shape, with a multivariable-adjusted HR of 1.40 (95% CI: 1.15-1.70; < 0.001) per 1-SD higher log-transformed hs-cTnT value. The strength of association was similar when further adjusted for other potential confounders and across clinically relevant subgroups. Corresponding outcome-specific HRs were 1.33 (95% CI: 1.06-1.68; = 0.016) for stroke, 1.28 (95% CI: 0.69-2.37; = 0.430) for myocardial infarction, 1.98 (95% CI: 1.43-2.73; < 0.001) for CVD death, and 1.93 (95% CI: 1.54-2.41; < 0.001) for all-cause death.
High hs-cTnT is associated with increased CVD risk in ischemic stroke and transient ischemic attack patients.
高敏心肌肌钙蛋白T（hs-cTnT）通常与心血管疾病（CVD）风险以及各种高危人群相关。
本研究的目的是精确描述hs-cTnT与急性缺血性卒中或短暂性脑缺血发作患者CVD风险之间的关联。
我们对STROKE-CARD试验（NCT02156778）的数据进行了事后分析，该试验是一项针对急性缺血性卒中或短暂性脑缺血发作（ABCD评分≥3）患者的疾病管理计划的实用随机对照试验。我们在入院时测量了hs-cTnT（罗氏电化学发光法，检测限5 ng/L），并对年龄、性别、既往冠心病、既往心力衰竭、糖尿病、吸烟、收缩压以及低密度和高密度脂蛋白胆固醇进行校正后，对复合CVD结局（即卒中、心肌梗死、CVD死亡）的风险比（HR）进行了量化。
在1687例患者中（平均年龄69.3±13.7岁；40.7%为女性），80.7%的患者可检测到hs-cTnT。hs-cTnT的中位数为10 ng/L（四分位间距：6 - 18 ng/L）。在中位随访12.1个月期间，110例患者发生了CVD事件。hs-cTnT水平与CVD风险的关联呈对数线性，每增加1个标准差的对数转换hs-cTnT值，多变量校正后的HR为1.40（95%CI：1.15 - 1.70；P<0.001）。在进一步调整其他潜在混杂因素后以及在临床相关亚组中，关联强度相似。相应的特定结局HR分别为：卒中1.33（95%CI：1.06 - 1.68；P = 0.016），心肌梗死1.28（95%CI：0.69 - 2.37；P = 0.430），CVD死亡1.98（95%CI：1.43 - 2.73；P<0.001），全因死亡1.93（95%CI：1.54 - 2.41；P<0.001）。
高hs-cTnT与缺血性卒中和短暂性脑缺血发作患者的CVD风险增加相关。
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