Type 1 Myocardial Infarction in Patients With Acute Ischemic Stroke

TY - JOUR

T1 - Type 1 Myocardial Infarction in Patients With Acute Ischemic Stroke

AU - Nolte, Christian H

AU - von Rennenberg, Regina

AU - Litmeier, Simon

AU - Leistner, David M

AU - Szabo, Kristina

AU - Baumann, Stefan

AU - Mengel, Annerose

AU - Michalski, Dominik

AU - Siepmann, Timo

AU - Blankenberg, Stephan

AU - Petzold, Gabor C

AU - Dichgans, Martin

AU - Katus, Hugo

AU - Pieske, Burkert

AU - Regitz-Zagrosek, Vera

AU - Braemswig, Tim Bastian

AU - Rangus, Ida

AU - Pepic, Amra

AU - Vettorazzi, Eik

AU - Zeiher, Andreas M

AU - Scheitz, Jan F

AU - Wegscheider, Karl

AU - Landmesser, Ulf

AU - Endres, Matthias

PY - 2024/7/1

Y1 - 2024/7/1

N2 - IMPORTANCE: Elevated values of high-sensitivity cardiac troponin (hs-cTn) are common in patients with acute ischemic stroke and are associated with poor prognosis. However, diagnostic and therapeutic implications in patients with ischemic stroke remain unclear.OBJECTIVE: To identify factors indicative of myocardial infarction (MI) in patients with acute ischemic stroke and hs-cTn elevation. The primary hypothesis was that a dynamic change of hs-cTn values (>50% change) in patients with acute ischemic stroke indicates MI.DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was a prospective, observational study with blinded end-point assessment conducted across 26 sites in Germany. Patients were included if they had acute ischemic stroke within 72 hours and either (1) highly elevated hs-cTn values on admission (>52 ng/L) or (2) hs-cTn levels above the upper limit of normal and a greater than 20% change at repeated measurements. Patients were enrolled between August 2018 and October 2020 and had 1 year of follow-up. Statistical analysis was performed between April 2022 and August 2023.EXPOSURE: Standardized electrocardiography, echocardiography, and coronary angiography.MAIN OUTCOME AND MEASURES: Diagnosis of MI as adjudicated by an independent end-point committee based on the findings of electrocardiography, echocardiography, and coronary angiography.RESULTS: In total, 254 patients were included. End points were adjudicated in 247 patients (median [IQR] age, 75 [66-82] years; 117 were female [47%] and 130 male [53%]). MI was present in 126 of 247 patients (51%) and classified as type 1 MI in 50 patients (20%). Dynamic change in hs-cTn value was not associated with MI in univariable (32% vs 38%; χ2 P = .30) or adjusted comparison (odds ratio, 1.05; 95% CI, 0.31-3.33). The baseline absolute hs-cTn value was independently associated with type 1 MI. The best cutoffs for predicting type 1 MI were at hs-cTn values 5 to 10 times the upper limit normal.CONCLUSIONS AND RELEVANCE: This study found that in patients with acute ischemic stroke, a dynamic change in hs-cTn values did not identify MI, underscoring that dynamic changes do not identify the underlying pathophysiological mechanism. In exploratory analyses, very high absolute hs-cTn values were associated with a diagnosis of type 1 MI. Further studies are needed how to best identify patients with stroke who should undergo coronary angiography.

AB - IMPORTANCE: Elevated values of high-sensitivity cardiac troponin (hs-cTn) are common in patients with acute ischemic stroke and are associated with poor prognosis. However, diagnostic and therapeutic implications in patients with ischemic stroke remain unclear.OBJECTIVE: To identify factors indicative of myocardial infarction (MI) in patients with acute ischemic stroke and hs-cTn elevation. The primary hypothesis was that a dynamic change of hs-cTn values (>50% change) in patients with acute ischemic stroke indicates MI.DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was a prospective, observational study with blinded end-point assessment conducted across 26 sites in Germany. Patients were included if they had acute ischemic stroke within 72 hours and either (1) highly elevated hs-cTn values on admission (>52 ng/L) or (2) hs-cTn levels above the upper limit of normal and a greater than 20% change at repeated measurements. Patients were enrolled between August 2018 and October 2020 and had 1 year of follow-up. Statistical analysis was performed between April 2022 and August 2023.EXPOSURE: Standardized electrocardiography, echocardiography, and coronary angiography.MAIN OUTCOME AND MEASURES: Diagnosis of MI as adjudicated by an independent end-point committee based on the findings of electrocardiography, echocardiography, and coronary angiography.RESULTS: In total, 254 patients were included. End points were adjudicated in 247 patients (median [IQR] age, 75 [66-82] years; 117 were female [47%] and 130 male [53%]). MI was present in 126 of 247 patients (51%) and classified as type 1 MI in 50 patients (20%). Dynamic change in hs-cTn value was not associated with MI in univariable (32% vs 38%; χ2 P = .30) or adjusted comparison (odds ratio, 1.05; 95% CI, 0.31-3.33). The baseline absolute hs-cTn value was independently associated with type 1 MI. The best cutoffs for predicting type 1 MI were at hs-cTn values 5 to 10 times the upper limit normal.CONCLUSIONS AND RELEVANCE: This study found that in patients with acute ischemic stroke, a dynamic change in hs-cTn values did not identify MI, underscoring that dynamic changes do not identify the underlying pathophysiological mechanism. In exploratory analyses, very high absolute hs-cTn values were associated with a diagnosis of type 1 MI. Further studies are needed how to best identify patients with stroke who should undergo coronary angiography.

U2 - 10.1001/jamaneurol.2024.1552

DO - 10.1001/jamaneurol.2024.1552

M3 - SCORING: Journal article

C2 - 38829625

VL - 81

SP - 703

EP - 711

JO - JAMA NEUROL

JF - JAMA NEUROL

SN - 2168-6149

IS - 7

ER -