Prognostic Value of High-sensitivity Cardiac Troponin T in Acute Ischemic Stroke
Prognostic Value of High-sensitivity Cardiac Troponin T in Acute Ischemic Stroke
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DOI：
10.1016/j.jstrokecerebrovasdis.2013.01.005
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发表时间：
2014-02-01
影响因子：
2.5
通讯作者：
Ronning, Ole Morten
中科院分区：
文献类型：
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作者：
Faiz, Kashif Waqar;Thommessen, Bente;Ronning, Ole Morten
背景：心肌肌钙蛋白作为缺血性脑卒中的预后指标已被研究，但结果不一。最近开发了新一代高灵敏度肌钙蛋白测定法，可以检测到比传统测定法低5至10倍的浓度。本研究的目的是确定入院时高敏感性心肌肌钙蛋白T （hs-cTnT）升高与急性缺血性卒中后死亡率之间的关系。方法：对347例急性缺血性脑卒中患者入院时血清hs-cTnT浓度进行测定。获得临床资料和背景资料。总随访时间为1.5±0.7年，全因死亡率作为结局指标。结果：全组入院时hs-cTnT中位数为15.2 ng/L（四分位间距[IQR] 7.5-27.8），非幸存者高于幸存者（28.2 ng/L [IQR 15.6-39.5] vs 11.4 ng/L [IQR 6.0-21.2]; P < .001）。在多因素分析中，高hs-cTnT（第四个四分位数）与随访期间的全因死亡率独立相关，风险比为1.65（95%可信区间[CI] 1.04-2.63; P = 0.035）。在多变量模型中加入hs-cTnTas这一连续变量，导致患者的鉴别和再分类均增加（c指数从0.819增加到0.834 [P = .007]；综合鉴别指数为0.011 [95% CI 0.001-0.021; P = .028]）。结论：循环hs-cTnT水平与急性缺血性卒中患者的死亡风险密切相关，即使低于参考上限的水平似乎也具有预后价值。
Background: Cardiac troponins have been investigated as prognostic markers in the setting of ischemic stroke with diverging results. A new generation of highly sensitive troponin assays have recently been developed that allow for the detection of concentrations 5 to 10 times lower than those measureable with conventional assays. The aim of this study was to determine the association between high-sensitivity cardiac troponin T (hs-cTnT) elevation on admission and mortality after acute ischemic stroke. Methods: Serum concentrations of hs-cTnT were measured at the time of admission in 347 patients with acute ischemic stroke. Clinical data and background information were obtained. Total follow-up time was 1.5 +/- 0.7 years, and all-cause mortality was used as the outcome measure. Results: Median hs-cTnT on admission in the whole group was 15.2 ng/L (interquartile range [IQR] 7.5-27.8), and was higher in nonsurvivors than survivors (28.2 ng/L [IQR 15.6-39.5] vs 11.4 ng/L [IQR 6.0-21.2]; P < .001). In multivariate analysis, high hs-cTnT (the fourth quartile) was independently associated with all-cause mortality during the follow-up period, with a hazard ratio of 1.65 (95% confidence interval [CI] 1.04-2.63; P = .035). The addition of hs-cTnTas a continuous variable to the multivariate model resulted in both incremental discrimination and reclassification of patients (C-index increase from 0.819 to 0.834 [P = .007]; integrated discrimination index 0.011 [95% CI 0.001-0.021; P = .028]). Conclusions: Circulating hs-cTnT levels are closely associated with the risk of death in patients with acute ischemic stroke, and even levels below the upper reference limit appear to have prognostic value.