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Troponin T in Prediction of Culprit Lesion Coronary Artery Disease and 1-Year Major Adverse Cerebral and Cardiovascular Events in Patients with Acute Stroke

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Abstract

Troponin T (TnT) elevation above the 99th percentile upper reference limit (URL) is considered diagnostic of acute myocardial infarction (MI). Non-specific increases of TnT are frequent in acute stroke patients. However, in these patients, correct diagnosis of MI is crucial because the antithrombotic medications used to treat acute MI might be harmful and produce intracranial bleeding. In this study, we aimed to associate enhanced TnT levels defined by different cutoff values with occurrence of culprit lesion coronary artery disease (CAD) as well as 1-year major adverse cerebral and cardiovascular events (MACCEs). In this cohort study, we investigated 84 consecutive patients with acute ischemic stroke and concomitant MI. TnT levels were measured using a fourth-generation TnT assay. The incidence of culprit lesion CAD was determined by coronary angiography. MACCEs were recorded during 1-year follow-up. Culprit lesion CAD occurred in 55 % of patients, and 1-year MACCE in 37 %. TnT levels above the manufacturers’ provided 99th URL (TnT > 0.01) were not associated with culprit lesion CAD (relative risk [RR], 1.3; 95 % confidence interval [CI] 0.96–1.8; P = 0.09). Slightly increased cutoff level (TnT > 0.03) increased specificity and was associated with culprit lesion CAD without decreasing sensitivity (RR, 1.5; 95 % CI 1.1–2.2; P = 0.021) and 1-year MACCE (RR, 1.7; 95 % CI 1.3–2.3; P < 0.001). Slightly increasement of the TnT cutoff level predicted MACCEs and is superior in prediction of culprit lesion CAD in stroke patients without being less sensitive. This finding has to be confirmed in large-scale clinical trials.

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Abbreviations

CAD:

Coronary artery disease

MACCE:

Major adverse cerebral and cardiovascular event

MI:

Myocardial infarction

TIA:

Transient ischemic attack

TnT:

Troponin T

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Authors’ contributions

T.Z. and A.P. designed the study, analyzed and interpreted data, and wrote the manuscript. U.K., D.L., L.G., R.W., F.B., and M.G. collected data and revised the manuscript. S.J. and M.K. supervised the study and revised the manuscript.

Financial support

Dr. Polzin is funded by the Forschungskommission of the Medical Faculty of the Heinrich Heine University (No. 16-2014).

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Authors and Affiliations

  1. Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany

    Tobias Zeus, Ulrike Ketterer, Daniela Leuf, Lisa Dannenberg, Rabea Wagstaff, Florian Bönner, Malte Kelm & Amin Polzin

  2. Department of Neurology, Heinrich Heine University, Dusseldorf, Germany

    Michael Gliem & Sebastian Jander

Authors
  1. Tobias Zeus
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  2. Ulrike Ketterer
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  3. Daniela Leuf
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  4. Lisa Dannenberg
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  5. Rabea Wagstaff
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  6. Florian Bönner
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  7. Michael Gliem
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  8. Sebastian Jander
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  9. Malte Kelm
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  10. Amin Polzin
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Correspondence to Amin Polzin.

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Funding source

Dr. Polzin is funded by the Forschungskommission of the Medical Faculty of the Heinrich Heine University (No. 16-2014).

Ethics Committee Approval

The study conformed to the Declaration of Helsinki and was approved by the University of Düsseldorf Ethics Committee.

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Zeus, T., Ketterer, U., Leuf, D. et al. Troponin T in Prediction of Culprit Lesion Coronary Artery Disease and 1-Year Major Adverse Cerebral and Cardiovascular Events in Patients with Acute Stroke. Transl. Stroke Res. 7, 180–185 (2016). https://doi.org/10.1007/s12975-016-0457-7

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  • DOI: https://doi.org/10.1007/s12975-016-0457-7

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