Type 1 Myocardial Infarction in Patients With Acute Ischemic Stroke
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Type 1 Myocardial Infarction in Patients With Acute Ischemic Stroke. / Nolte, Christian H; von Rennenberg, Regina; Litmeier, Simon; Leistner, David M; Szabo, Kristina; Baumann, Stefan; Mengel, Annerose; Michalski, Dominik; Siepmann, Timo; Blankenberg, Stephan; Petzold, Gabor C; Dichgans, Martin; Katus, Hugo; Pieske, Burkert; Regitz-Zagrosek, Vera; Braemswig, Tim Bastian; Rangus, Ida; Pepic, Amra; Vettorazzi, Eik; Zeiher, Andreas M; Scheitz, Jan F; Wegscheider, Karl; Landmesser, Ulf; Endres, Matthias.
In: JAMA NEUROL, Vol. 81, No. 7, 01.07.2024, p. 703-711.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -