Ma Shenghui, Li Jiawen, Kong Qi, Xu Zhiming, Wu Haojie, Jin Yujia, Ye Xianghua, Luo Dong, Tong Lusha, Gao Feng
Department of Cardiology The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou Zhejiang China.
State Key Laboratory of Transvascular Implantation Devices Hangzhou China.
J Am Heart Assoc. 2025 Feb 4;14(3):e037053. doi: 10.1161/JAHA.124.037053. Epub 2025 Jan 23.
Myocardial injury is common after brain injury; however, few studies have reported serial cardiac troponin (cTn) measurements to distinguish whether the myocardial injury is acute or chronic. The fourth Universal Definition of Myocardial Infarction introduced for the first time the criteria for acute myocardial injury (AMI). We aimed to investigate the prevalence and prognostic implications of AMI in primary intracerebral hemorrhage.
We retrospectively analyzed patients with primary intracerebral hemorrhage within 48 hours after symptom onset. All patients included had at least 2 cTn measurements: 1 obtained at the time of emergency admission and at least 1 more within the first 2 days of hospitalization. AMI was defined as an elevated cTn above the upper-reference limit (14 ng/L) along with a rise/fall >20%. Patients were followed for up to 5 years. Outcomes included major adverse cardiac events (MACEs; a composite of vascular death, nonfatal coronary events, and nonfatal stroke) and 90-day unfavorable outcomes (modified Rankin scale score ≥4). Cox proportional hazards models, multivariable logistic regression models, and Kaplan-Meier analyses were used to evaluate the association between AMI and outcomes. Of 600 patients included, 115 had AMI (19.2%). AMI independently conferred an increased risk for major adverse cardiac events (adjusted hazard ratio, 1.69 [95% CI, 1.12-2.53]) and 90-day unfavorable outcomes (adjusted odds ratio, 2.15 [95% CI, 1.26-3.67]) compared with patients without AMI.
AMI is relatively common in patients with intracerebral hemorrhage and is associated with both long-term major adverse cardiac events and 90-day unfavorable outcomes.
脑损伤后心肌损伤很常见；然而，很少有研究报告连续检测心肌肌钙蛋白（cTn）以区分心肌损伤是急性还是慢性。第四次心肌梗死全球定义首次引入了急性心肌损伤（AMI）的标准。我们旨在研究原发性脑出血中AMI的患病率及其预后意义。
我们回顾性分析了症状发作后48小时内的原发性脑出血患者。所有纳入患者至少进行了2次cTn检测：1次在急诊入院时进行，住院的头2天内至少再进行1次。AMI定义为cTn升高超过参考上限（14 ng/L）且上升/下降>20%。对患者进行了长达5年的随访。结局包括主要不良心脏事件（MACE；血管性死亡、非致命性冠状动脉事件和非致命性卒中的复合事件）和90天不良结局（改良Rankin量表评分≥4）。使用Cox比例风险模型、多变量逻辑回归模型和Kaplan-Meier分析来评估AMI与结局之间的关联。在纳入的600例患者中，115例有AMI（19.2%）。与无AMI的患者相比，AMI独立增加了主要不良心脏事件（调整后风险比，1.69 [95% CI，1.12 - 2.53]）和90天不良结局（调整后优势比，2.15 [95% CI，1.26 - 3.67]）的风险。
AMI在脑出血患者中相对常见，并且与长期主要不良心脏事件和90天不良结局均相关。
