Cardiac Troponin and Recurrent Major Vascular Events after Minor Stroke or Transient Ischemic Attack
| العنوان: | Cardiac Troponin and Recurrent Major Vascular Events after Minor Stroke or Transient Ischemic Attack |
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| المؤلفون: | Simon Hellwig, Heinrich J. Audebert, Matthias Endres, Jan F. Scheitz, Thomas Ihl, Ramanan Ganeshan, Inga Laumeier, Joachim E. Weber, Michael Ahmadi, Maureen Steinicke |
| المصدر: | Annals of neurology 90(6), 901-912 (2021). doi:10.1002/ana.26225 |
| بيانات النشر: | Wiley, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Male, blood [Troponin T], medicine.medical_specialty, complications [Ischemic Attack, Transient], Lower risk, Risk Assessment, Troponin T, Recurrence, Risk Factors, Internal medicine, Post-hoc analysis, medicine, Humans, complications [Stroke], ddc:610, cardiovascular diseases, Stroke, Aged, Aged, 80 and over, blood [Biomarkers], Ischemic Attack, business.industry, blood [Ischemic Attack, Transient], Hazard ratio, Middle Aged, Prognosis, medicine.disease, Troponin, Confidence interval, blood [Stroke], Blood pressure, Neurology, Ischemic Attack, Transient, Propensity score matching, Cardiology, Female, Neurology (clinical), business, Biomarkers, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit, Mace |
| الوصف: | OBJECTIVE This study was undertaken to investigate whether high-sensitivity cardiac troponin T (hs-cTnT) is associated with major adverse cardiovascular events (MACE) in patients with minor stroke or transient ischemic attack (TIA), and whether this association differs after risk stratification based on the Age, Blood Pressure, Clinical Features, Duration of Symptoms, Diabetes (ABCD2 ) score. METHODS INSPiRE-TMS was a randomized controlled trial allocating patients with minor stroke or TIA to an intensified support program or conventional care. In this post hoc analysis, participants were categorized using hs-cTnT levels (5th generation; Roche Diagnostics, Manheim, Germany; 99th percentile upper reference limit [URL] = 14ng/l). Vascular risk was stratified using the ABCD2 score (lower risk = 0-5 vs higher risk = 6-7). Cox proportional hazard regression was performed using covariate adjustment and propensity score matching (PSM) for the association between hs-cTnT and MACE (stroke/nonfatal coronary event/vascular death). RESULTS Among 889 patients (mean age = 70 years, 37% female), MACE occurred in 153 patients (17.2%) during a mean follow-up of 3.2 years. hs-cTnT was associated with MACE (9.3%/yr, >URL vs 4.4%/yr, ≤URL, adjusted hazard ratio [HR] = 1.63 [95% confidence interval (CI) = 1.13-2.35], adjusted HR [Q4 vs Q1 ] = 2.57 [95% CI = 1.35-4.97], adjusted HR [log-transformed] = 2.31 [95% CI = 1.37-3.89]). This association remained after PSM (adjusted HR = 1.76 [95% CI = 1.14-2.72]). There was a significant interaction between hs-cTnT and ABCD2 category for MACE occurrence (pinteraction = 0.04). In the lower risk category, MACE rate was 9.5%/yr in patients with hs-cTnT > URL, which was higher than in those ≤URL (3.8%/yr) and similar to the overall rate in the higher risk category. INTERPRETATION hs-cTnT levels are associated with incident MACE within 3 years after minor stroke or TIA and may help to identify high-risk individuals otherwise deemed at lower risk based on the ABCD2 score. If confirmed in independent validation studies, this might warrant intensified secondary prevention measures and cardiac diagnostics in stroke patients with elevated hs-cTnT. ANN NEUROL 2021;90:901-912. |
| تدمد: | 1531-8249 0364-5134 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1d449874508d6a5fa341178dbc61e2f6Test https://doi.org/10.1002/ana.26225Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....1d449874508d6a5fa341178dbc61e2f6 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15318249 03645134 |
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