Prevalence of Positive Troponin and Echocardiogram Findings and Association With Mortality in Acute Ischemic Stroke.
Prevalence of Positive Troponin and Echocardiogram Findings and Association With Mortality in Acute Ischemic Stroke.
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DOI：
10.1161/strokeaha.116.014561
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发表时间：
2017-05
期刊：
影响因子：
8.3
通讯作者：
Kleindorfer DO
中科院分区：
文献类型：
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作者：
Wrigley P;Khoury J;Eckerle B;Alwell K;Moomaw CJ;Woo D;Flaherty ML;De Los Rios la Rosa F;Mackey J;Adeoye O;Martini S;Ferioli S;Kissela BM;Kleindorfer DO
急性缺血性卒中（AIS）患者可能在入院时血清肌钙蛋白（cTn）水平升高，尽管尚不清楚这有什么预后意义，以及升高的水平是否与卒中的心脏原因或超声心动图上观察到的结构性心脏病相关。我们在一个大的birthday AIS人群中调查了cTn和超声心动图检测的阳性率，以及与卒中后死亡率的任何相关性。在130万的集水区内，我们使用ICD-9出院代码430-436筛查了2010年以来的艾德入院病例，并通过回顾性病历审查确定了所有经医生证实的AIS病例。高肌钙蛋白血症定义为cTn升高超过标准第99百分位数。进行了多因素logistic回归分析，控制了卒中严重程度、心脏病史和所有其他卒中风险因素。在1999例AIS病例中，1706例（85.3%）采集了cTn，1590例（79.5%）进行了超声心动图检查。353/1706例（20.7%）发生高肌钙蛋白血症。160/1590（10.1%）例患者的超声心动图结果值得关注。在1377名同时进行两项检查的患者中，高肌钙蛋白血症与超声心动图结果独立相关（OR 2.9 95%CI 2-4.2）。当排除并发心肌梗死（MI，3.5%）时，高肌钙蛋白血症也与1年（35%，OR 3.45 95% CI 2.1-5.6）和3年（60%，OR 2.91 95% CI 2.06-4.11）死亡率增加相关。在无并发MI的AIS背景下，高肌钙蛋白血症与结构性心脏病和长期死亡率相关。需要前瞻性研究来确定进一步的心脏评估是否可以改善该组的长期死亡率。
Acute ischemic stroke (AIS) patients may have raised serum troponin (cTn) levels on admission, although it is unclear what prognostic implications this has, and whether elevated levels are associated with cardiac causes of stroke or structural cardiac disease as seen on echocardiogram. We investigated the positivity of cTn and echocardiogram testing within a large biracial AIS population, and any association with post stroke mortality. Within a catchment area of 1.3 million we screened ED admissions from 2010 using ICD-9 discharge codes 430–436 and ascertained all physician-confirmed AIS cases by retrospective chart review. Hypertroponinemia was defined as elevation in cTn above the standard 99th percentile. Multiple logistic regression was performed, controlling for stroke severity, history of cardiac disease and all other stroke risk factors. Of 1999 AIS cases, 1706 (85.3%) had a cTn drawn and 1590 (79.5%) had echocardiograms. Hypertroponinemia occurred in 353/1706 (20.7%). 160/1590 (10.1%) had echocardiogram findings of interest. Among 1377 who had both tests performed, hypertroponinemia was independently associated with echocardiogram findings (OR 2.9 95% CI 2–4.2). When concurrent myocardial infarctions (MI, 3.5%) were excluded, hypertroponinemia was also associated with increased mortality at 1 year (35%, OR 3.45 95% CI 2.1–5.6) and 3 years (60%, OR 2.91 95% CI 2.06–4.11). Hypertroponinemia in the context of AIS without concurrent MI was associated with structural cardiac disease and long-term mortality. Prospective studies are needed to determine if further cardiac evaluation might improve the long-term mortality rates seen in this group.