Abstract
Introduction:
Troponin elevations due to Type II myocardial infarction (T2MI) are associated with increased mortality after hemorrhagic stroke but there is little data on stroke severity or outcome following ischemic stroke.
Methods:
All stroke discharges from UH-Case Medical Center between 1/2013- 4/2015 were reviewed for demographics, vascular risk factors, admission stroke severity, labs, echocardiogram results and discharge disposition. Troponin levels were normal (<0.04ng/ml), high (0.04-0.5ng/ml), or critical (>0.5ng/ml). A T2MI was diagnosed by a trending troponin elevation; patients with T1MI were excluded. Analyses used SPSS.
Results:
Troponin levels were normal in 65%, high in 28% and critical in 7% in 1655 patients (1052 ischemic stroke, 434 intracerebral hemorrhage, 169 subarachnoid hemorrhage) and were associated with admission stroke severity (figure). Ischemic stroke patients were mean age 69 yrs (20-101), 50.4% female with mean admission NIHSS 9.3 (0-36). T2MI was associated with higher NIHSS >10 (p=.000), SCr (p=.000) and age (p=.005), lower LDL (p=.000) and SBP (p=.012), and history of AF (p=.021), CAD (p=.000), and HF (p=.000). The significant association with admission NIHSS (p=.002) persisted after adjustment for age (p = .056), gender, LDL (p = .007), CAD (p= .023), heart failure (p = .003), atrial fibrillation, systolic BP, A1C, BMI, and SCr (p=.009). Initial troponin levels for the 8.3% who died or DC to hospice were high in 43% and critical in 24%. Initial and peak troponin levels were significantly associated with DC disposition (p=.000).
Conclusion:
Elevated troponin due to T2MI is significantly associated with admission ischemic stroke severity, persisting after adjustment of other risk factors, and predicts a poorer outcome. Troponin levels should be obtained on admission for acute stroke to establish the diagnosis of T2MI and capture its impact as a major comorbid condition.