Association Between High-Sensitivity Cardiac Troponin and Risk of Stroke in 96 702 Individuals A Meta-Analysis
Association Between High-Sensitivity Cardiac Troponin and Risk of Stroke in 96 702 Individuals A Meta-Analysis
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DOI：
10.1161/strokeaha.119.028323
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发表时间：
2020-04-01
期刊：
影响因子：
8.3
通讯作者：
Scheitz, Jan F.
中科院分区：
文献类型：
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作者：
Broersen, Leonie H. A.;Stengl, Helena;Scheitz, Jan F.
背景和目的：我们的研究目的是基于hs-cTn（高敏感性心肌肌钙蛋白）水平（一种指示心肌损伤的特定生物标志物），在普通人群、房颤患者和既往卒中患者中估计卒中事件的风险。方法：检索embase、PubMed和Web of Science，直到2019年3月14日，以确定相关文章。基于hs-cTn评估卒中风险的随机对照试验和队列研究符合条件。由于每个人群的研究异质性，分别对hs-cTn（分类/连续数据）、hs-cTn亚单位（T或I）、低偏倚风险、全因卒中和缺血性卒中进行编码，使用随机效应模型计算合并校正风险比，包括95% CI。结果：纳入17篇文献，96 702名受试者。在普通人群中进行的研究（n=12； 77780名参与者）中，在平均随访1至20年（中位数为10年）期间，高hs-cTn与低hs-cTn（由纳入的研究定义）的合并校正卒中风险比为1.25 （CI, 1.10-1.40）。当使用分类数据时，这增加到1.58 （CI, 1.26-1.90）。当考虑到卒中分类（全因卒中/缺血性卒中）、hs-cTn亚基、偏倚风险和hs-cTn编码时，结果是稳健的。在房颤患者中（4项研究，18 725名受试者），高hs-cTn与低hs-cTn的合并校正卒中风险比为1.95 （CI, 1.29-2.62）。由于缺乏数据（一项研究，197名参与者），无法对既往卒中患者进行荟萃分析。结论：本荟萃分析提示hs-cTn可作为卒中发生的危险标志物，不同亚组的效应大小不同。在高危人群中，特别是有缺血性脑卒中病史的患者中，需要更多的研究hs-cTn与卒中发生率之间的关系。
Background and Purpose-Our study aim was to estimate risk of incident stroke based on levels of hs-cTn (high-sensitivity cardiac troponin), a specific biomarker indicating myocardial injury, in the general population, patients with atrial fibrillation, and patients with previous stroke.Methods-Embase, PubMed, and Web of Science were searched until March 14, 2019 to identify relevant articles. Randomized controlled trials and cohort studies assessing the risk of incident stroke based on hs-cTn were eligible. Pooled adjusted hazard ratios including 95% CI were calculated using a random-effects model due to study heterogeneity per population, coding of hs-cTn (categorical/continuous data), per hs-cTn subunit (T or I), for low risk of bias, and for all-cause and ischemic stroke separately.Results-We included 17 articles with 96 702 participants. In studies conducted in the general population (n=12; 77 780 participants), the pooled adjusted hazard ratio for incident stroke was 1.25 (CI, 1.10-1.40) for high versus low hs-cTn (as defined by included studies) during an average follow-up of 1 to 20 years (median 10). When categorical data were used, this was increased to 1.58 (CI, 1.26-1.90). The results were robust when accounting for stroke classification (all-cause stroke/ischemic stroke), hs-cTn subunit, risk of bias, and coding of hs-cTn. In patients with atrial fibrillation (4 studies; 18 725 participants), the pooled adjusted hazard ratio for incident stroke was 1.95 (CI, 1.29-2.62) for high versus low hs-cTn. Due to lack of data (one study, 197 participants), no meta-analysis could be performed in patients with previous stroke.Conclusions-This meta-analysis suggests that hs-cTn can be regarded as a risk marker for incident stroke, with different effect size in different subgroups. More research about the association between hs-cTn and incident stroke in high-risk populations is needed, especially in patients with history of ischemic stroke.