What Does Elevated High-Sensitive Troponin I in Stroke Patients Mean: Concomitant Acute Myocardial Infarction or a Marker for High-Risk Patients?
What Does Elevated High-Sensitive Troponin I in Stroke Patients Mean: Concomitant Acute Myocardial Infarction or a Marker for High-Risk Patients?
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DOI：
10.1159/000353875
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发表时间：
2013-01-01
影响因子：
2.9
通讯作者：
Fatar, M.
中科院分区：
文献类型：
--
作者：
Anders, B.;Alonso, A.;Fatar, M.
背景：急性缺血性卒中患者可能偶尔合并急性冠状动脉综合征（ACS）。肌钙蛋白I和T是检测ACS的既定生物标志物。最近引入的高灵敏度心肌肌钙蛋白（hs-TNI和hs-TNT）检测越来越多地用于识别中风患者的ACS，即使没有ACS的体征或症状。这些新的检测系统经常检测到hs-肌钙蛋白的升高值，尽管到目前为止尚不清楚这些患者中hs-TNI值升高的临床相关性和后果。患者和方法：我们检查了1年内入住综合中风中心的834名连续缺血性中风患者的hs-TNI值。入院后立即测量hs-TNI，如果初始hs-TNI高于正常值的第99百分位数（>0.045 ng/ml），则在3 h后测量hs-TNI。将hs-TNI值升高的患者分为两组：（1）恒定和（2）动态hs-TNI值。动态方法定义为hs-TNI值在3 h内上升或下降超过临界值30%。所有患者均根据国际卒中单元标准接受卒中诊断和连续监测，包括12导联ECG、血压、体温和连续ECG监测，以及定期6小时神经系统和全身体格检查（包括NIHSS评分）。作为卒中单元团队的成员，心脏病专家评估了临床症状/检查以及实验室、超声心动图和ECG结果，以诊断ACS。结果：172/834例（20.6%）患者入院时hs-TNI水平升高。hs-TNI值升高的患者表现出显著的（P < 0.001）高血压患病率增加（89 vs. 77.2%），卒中史（24.4 vs. 14.8%），冠状动脉疾病史（65.7 vs. 34.1%）、心肌梗死（22.1 vs. 7.6%）、心力衰竭（12.8 vs. 5.7%）和房颤（44.2 vs. 23.6%）病史。136例患者中，82例hs-TNI值为恒定，54例hs-TNI值为动态，5例诊断为ST段抬高型心肌梗死（STEMI），24例诊断为非ST段抬高型心肌梗死（NSTEMI）。结论：我们的数据表明，hs-TNI升高约20.6%的急性缺血性卒中患者，但治疗相关的ACS被诊断为动态组。无ACS的脑卒中患者由于不同的心脏应激原因，可出现hs-TNI无动态变化的升高。因此，我们认为hs-TNI是一个敏感的标志物，以检测高风险的患者，但系列测量是强制性的，专家的心脏检查是必不可少的最佳医疗和准确诊断急性缺血性卒中患者的ACS。版权所有（C）2013 S. Karger AG，巴塞尔
Background: Acute ischemic stroke patients may occasionally suffer from concomitant acute coronary syndrome (ACS). Troponin I and T are established biomarkers to detect ACS. Recently introduced high-sensitive cardiac troponin (hs-TNI and hs-TNT) assays are increasingly used to identify ACS in stroke patients even without signs or symptoms of ACS. These new test systems very often detect elevated values of hs-troponin, although clinical relevance and consequences of elevated hs-TNI values in these patients are unclear so far. Patients and Methods: We examined hs-TNI values in 834 consecutive ischemic stroke patients admitted to our Comprehensive Stroke Center during a 1-year period. hs-TNI was measured immediately after admission and after 3 h if initial hs-TNI was elevated above the 99th percentile of normal values (>0.045 ng/ml). Patients with elevated values were divided into two groups: (1) constant and (2) dynamic hs-TNI values. The dynamic approach was defined as a 30% rise or fall of the hs-TNI value above the critical value within 3 h. All patients received stroke diagnostic and continuous monitoring according to international stroke unit standards, including a 12-lead ECG, blood pressure, body temperature and continuous ECG monitoring, as well as regular 6-hourly neurological and general physical examination (including NIHSS scores). The cardiologists - as members of the Stroke Unit team - evaluated clinical symptoms/examination, as well as laboratory, echocardiographic and ECG findings for the diagnosis of ACS. Results: 172/834 (20.6%) patients showed elevated hs-TNI levels on admission. Patients with elevated hs-TNI values exhibited a significantly (p < 0.001) increased rate of hypertension (89 vs. 77.2%), history of stroke (24.4 vs. 14.8%), history of coronary artery disease (65.7 vs. 34.1%), history of myocardial infarction (22.1 vs. 7.6%), heart failure (12.8 vs. 5.7%) and atrial fibrillation (44.2 vs. 23.6%). 82/136 patients showed constant and 54/136 patients dynamic hs-TNI values: among the latter, 5 patients were diagnosed with ST segment elevation myocardial infarction (STEMI) and 24 with non-STEMI (NSTEMI). Conclusion: Our data demonstrate that hs-TNI was elevated in about 20.6% of acute ischemic stroke patients but therapeutically relevant ACS was diagnosed only in the dynamic group. hs-TNI elevations without dynamic changes may occur in stroke patients without ACS due to different reasons that stress the heart. Therefore, we suppose that hs-TNI is a sensitive marker to detect high-risk patients but serial measurements are mandatory and expert cardiological workup is essential for best medical treatment and to accurately diagnose ACS in acute ischemic stroke patients. Copyright (C) 2013 S. Karger AG, Basel