Prediction of Acute Myocardial Infarction in Asian Patients With Acute Ischemic Stroke: The CTRAN Score

Luowei Chen; Shenqiang Yan; Yaode He; Wansi Zhong; Xiaoxian Gong; Min Lou; CASE-II Registry Investigators

doi:10.1016/j.jacasi.2022.08.008

Prediction of Acute Myocardial Infarction in Asian Patients With Acute Ischemic Stroke: The CTRAN Score

JACC Asia. 2022 Nov 29;2(7):845-852. doi: 10.1016/j.jacasi.2022.08.008. eCollection 2022 Dec.

Authors

Luowei Chen¹, Shenqiang Yan¹, Yaode He¹, Wansi Zhong¹, Xiaoxian Gong¹, Min Lou¹; CASE-II Registry Investigators

Affiliation

¹ Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.

Abstract

Background: Patients with acute ischemic stroke (AIS) are susceptible to acute myocardial infarction (AMI), which would lead to a dramatic increase of in-hospital mortality.

Objectives: The authors established and validated an easy-used model to stratify the risk of in-hospital AMI among patients with AIS.

Methods: We consecutively included patients with AIS who were admitted within 7 days from symptom onset in our prospectively maintained database (NCT04487340) from January 2016 to December 2020. In the derivation cohort from 70 centers, we developed a score to predict in-hospital AMI by integrating the bedside-accessible predictors identified via multivariable logistic regression. Then in the validation cohort from 22 centers, we externally evaluated the performance of this score.

Results: Overall, 96,367 patients were included. In-hospital AMI occurred in 392 (0.41%) patients. The final model, named CTRAN, incorporated 5 predictors including the history of coronary heart disease, malignant tumor, renal insufficiency, age, and baseline National Institutes of Health Stroke Scale score. The CTRAN score was confirmed in the validation cohort using receiver operating characteristic curve, which yielded an area under the curve of 0.758 (95% CI: 0.718-0.798).

Conclusions: The CTRAN score could be a good tool for clinicians to identify patients with AIS at high in-hospital AMI risk.

Keywords: AC, anterior circulation; AIS, acute ischemic stroke; AMI, acute myocardial infarction; AUC, area under the curve; CTRAN, the history of Coronary heart disease, malignant Tumor, Renal insufficiency, Age, and baseline NIHSS score; ICD, International Classification of Diseases; NIHSS, National Institutes of Health Stroke Scale; PC, posterior circulation; myocardial infarction; natriuretic peptides; risk; stroke.