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CLINICAL OUTCOMES OF ACUTE ISCHEMIC STROKE PATIENTS STRATIFIED BY CARDIAC TROPONIN-I: A RETROSPECTIVE ANALYSIS
140 JACC March 21, 2017 Volume 69, Issue 11
Acute and Stable Ischemic Heart Disease CLINICAL OUTCOMES OF ACUTE ISCHEMIC STROKE PATIENTS STRATIFIED BY CARDIAC TROPONIN-I: A RETROSPECTIVE ANALYSIS Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical Presentation Number: 1166-348 Authors: Dylan Stanger, Siu Him Chan, Samuel Yip, Belinda Rodis, Andrew Starovoytov, Latonia Lam, Sonny Thiara, Christopher Cheung, Stephen Taylor, Ken Kaila, Carolyn Taylor, Krishnan Ramanathan, University of British Columbia, Vancouver, Canada, University of St. Andrews, St. Andrews, United Kingdom
Background: Elevation of cardiac troponin (cTn-I) in non-coronary artery disease conditions such as acute ischemic stroke (AIS) portends a poor prognosis. It is unclear if this poor prognosis is secondary to concomitant acute coronary syndrome (ACS), unmasking of highrisk stable coronary artery disease or a different etiology. The purpose of the current study was to evaluate the utility of elevated cTn-I in predicting occult coronary ischemia using non-invasive investigations in patients who presented with an AIS. Methods: Consecutive patients who presented with an AIS between January and December 2014 were included. All investigations were ordered by the AIS-treating physicians. cTn-I levels were correlated to findings on standard 12-lead electrocardiogram (ECG), 2D-echocardiogram and myocardial perfusion imaging studies by board-certified Cardiologists. The primary endpoint was the presence of reported ischemia on noninvasive testing. Secondary endpoints included length of stay, left ventricular ejection fraction, National Institutes of Health Stroke Scale (NIHSS) and mortality.
Results: 526 AIS registry patients were included in the analysis. Of these, cTn-I was measured in 380 patients and was abnormal in 120/380 (32%) patients. Ischemic changes on ECG and wall motion abnormality on 2D-echocardiography were more common in patients with elevated cTn-I compared to patients with normal cTn-I (19.8% vs. 11.6%, p = 0.036 and 34.2% vs. 11.6%, p = 0.026, respectively). Elevated cTn-I was associated with a longer length of stay (p = 0.044) and a trend toward higher mortality (p = 0.069) and NIHSS (p = 0.069). Patients with a history of atrial fibrillation, new atrial fibrillation or tPA administration were more likely to have an elevated cTn-I (p = 0.01, 0.08 and 0.021, respectively).
Conclusions: The current study demonstrated that cTn-I elevation in AIS is common and is associated with a significantly higher incidence of occult ischemia on noninvasive testing. Collaborative practices between Stroke Neurologists and Cardiologists are called for to further understand the implications of an elevated cTn-I in AIS patients and potential benefits of risk-stratification.
Acute and Stable Ischemic Heart Disease CLINICAL OUTCOMES OF ACUTE ISCHEMIC STROKE PATIENTS STRATIFIED BY CARDIAC TROPONIN-I: A RETROSPECTIVE ANALYSIS Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical Presentation Number: 1166-348 Authors: Dylan Stanger, Siu Him Chan, Samuel Yip, Belinda Rodis, Andrew Starovoytov, Latonia Lam, Sonny Thiara, Christopher Cheung, Stephen Taylor, Ken Kaila, Carolyn Taylor, Krishnan Ramanathan, University of British Columbia, Vancouver, Canada, University of St. Andrews, St. Andrews, United Kingdom
Background: Elevation of cardiac troponin (cTn-I) in non-coronary artery disease conditions such as acute ischemic stroke (AIS) portends a poor prognosis. It is unclear if this poor prognosis is secondary to concomitant acute coronary syndrome (ACS), unmasking of highrisk stable coronary artery disease or a different etiology. The purpose of the current study was to evaluate the utility of elevated cTn-I in predicting occult coronary ischemia using non-invasive investigations in patients who presented with an AIS. Methods: Consecutive patients who presented with an AIS between January and December 2014 were included. All investigations were ordered by the AIS-treating physicians. cTn-I levels were correlated to findings on standard 12-lead electrocardiogram (ECG), 2D-echocardiogram and myocardial perfusion imaging studies by board-certified Cardiologists. The primary endpoint was the presence of reported ischemia on noninvasive testing. Secondary endpoints included length of stay, left ventricular ejection fraction, National Institutes of Health Stroke Scale (NIHSS) and mortality.
Results: 526 AIS registry patients were included in the analysis. Of these, cTn-I was measured in 380 patients and was abnormal in 120/380 (32%) patients. Ischemic changes on ECG and wall motion abnormality on 2D-echocardiography were more common in patients with elevated cTn-I compared to patients with normal cTn-I (19.8% vs. 11.6%, p = 0.036 and 34.2% vs. 11.6%, p = 0.026, respectively). Elevated cTn-I was associated with a longer length of stay (p = 0.044) and a trend toward higher mortality (p = 0.069) and NIHSS (p = 0.069). Patients with a history of atrial fibrillation, new atrial fibrillation or tPA administration were more likely to have an elevated cTn-I (p = 0.01, 0.08 and 0.021, respectively).
Conclusions: The current study demonstrated that cTn-I elevation in AIS is common and is associated with a significantly higher incidence of occult ischemia on noninvasive testing. Collaborative practices between Stroke Neurologists and Cardiologists are called for to further understand the implications of an elevated cTn-I in AIS patients and potential benefits of risk-stratification.