Abstract WMP65: Association Between Troponin Levels and Visceral Infarction in Patients With Acute Ischemic Stroke

Autor: Santosh B. Murthy, Ajay Gupta, Alexander E Merkler, Peter Hung, Caitlin Finn, Shobana Ramasamy, Hooman Kamel, Praneil Patel, Peter M. Okin, Babak B. Navi
Rok vydání: 2019
Předmět:
Zdroj: Stroke. 50
ISSN: 1524-4628
0039-2499
DOI: 10.1161/str.50.suppl_1.wmp65
Popis: Introduction: Elevations in cardiac troponin in the absence of a clinically recognized acute myocardial infarction are typically seen in patients with acute ischemic stroke, though their significance remains unclear. Visceral infarcts appear to be more common in patients with embolic stroke subtypes, but their relation to troponin elevation remains uncertain. Methods: Among patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 through 2016, we included those with troponin measured within 24 hours from stroke onset and a contrast-enhanced abdominal computed tomographic scan within 1 year of admission. A troponin elevation was defined as a value exceeding our laboratory’s upper limit of normal (0.04 ng/mL) in the absence of a clinically recognized acute ST-segment elevation myocardial infarction. Visceral infarction was defined as a renal or splenic infarction as ascertained by a single radiologist blinded to patients’ other characteristics including troponin levels. Multiple logistic regression was used to evaluate the association between elevated troponin and visceral infarction after adjustment for demographics and comorbidities. Results: Among 2,116 patients registered in CAESAR from 2011-2016, 153 patients had a troponin assay and underwent a contrast-enhanced abdominal computed tomographic scan, of whom 33 (21%) had an elevated troponin and 22 (14%) had a visceral infarct. The prevalence of visceral infarction was higher among patients with an elevated troponin (30%; 95% CI, 16-49%) than among patients without an elevated troponin (10%; 95% CI, 5-17%) ( P = 0.003). After adjustment for demographics and comorbidities, we found a significant association between elevated troponin and visceral infarct (OR, 3.8; 95% CI, 1.2-11.7). Conclusions: Among patients with acute ischemic stroke, elevated troponin in the absence of a clinically recognized acute ST-segment elevation myocardial infarction was associated with visceral infarction, which is typically caused by embolism. Our results support the hypothesis that post-stroke troponin elevation indicates the presence of underlying embolic sources.
Databáze: OpenAIRE
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