Prognostic value of elevated high-sensitivity cardiac troponin T in acute ischemic stroke patients treated with endovascular thrombectomy in late time windows

Clin Neurol Neurosurg. 2021 Nov:210:106921. doi: 10.1016/j.clineuro.2021.106921. Epub 2021 Aug 29.

Abstract

Objective: To evaluate the prognostic significance of high-sensitivity cardiac troponin T (hs-cTnT) elevation in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) in the anterior circulation treated with endovascular thrombectomy (ET) in late time windows and identify the factors associated with hs-cTnT elevation.

Methods: A total of 152 AIS patients treated with ET in late time windows between January 2018 and August 2020 were included in this study. Patients were stratified into either normal or elevated hs-cTnT groups according to a cutoff value of 14 ng/L on admission. Baseline demographic features, comorbidities, and imaging data were compared between the elevated hs-cTnT group (＞14 ng/L) and the normal hs-cTnT group (≤14 ng/L). After accounting for these clinical characteristics, the association between hs-cTnT elevation and clinical outcomes was evaluated.

Results: 69(45.4%) patients had elevated hs-cTnT levels (>14 ng/L) on admission. The multivariable logistic regression analysis demonstrated that hs-cTnT elevation was independently associated with 3-month all-cause mortality (P = 0.014, OR 3.907, 95% CI 1.313-11.625) and 3-month composite unfavorable outcome (mRS 3-6) (P = 0.001, OR 5.099, 95% CI 1.873-13.888). Old age (P = 0.002, OR 1.053, 95% CI 1.020-1.088), admission NIHSS score (P = 0.015, OR 1.057, 95% CI 1.011-1.106), congestive heart failure (P = 0.016, OR 4.341, 95% CI 1.322-14.257) and coronary artery disease (P = 0.020, OR 2.914, 95% CI 1.183-7.180) were independently associated with hs-cTnT elevation.

Conclusion: In AIS patients treated with ET in late time windows, elevated hs-cTnT is independently associated with an increased risk of 3-month poor outcomes. Old age, high admission NIHSS score, coronary artery disease, and congestive heart failure are independent predictors of hs-cTnT elevation.

Keywords: Acute ischemic stroke; Endovascular thrombectomy; High-sensitivity cardiac troponin T; Late time windows; Prognosis.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain / diagnostic imaging*
  • Endovascular Procedures
  • Female
  • Humans
  • Ischemic Stroke / blood
  • Ischemic Stroke / diagnostic imaging
  • Ischemic Stroke / mortality
  • Ischemic Stroke / therapy*
  • Male
  • Middle Aged
  • Prognosis
  • Survival Rate
  • Thrombectomy*
  • Tomography, X-Ray Computed
  • Troponin T / blood*

Substances

  • TNNT2 protein, human
  • Troponin T