Type 1 Myocardial Infarction in Patients With Acute Ischemic Stroke

Nolte, Christian H.; Rennenberg, Regina von; 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 und Endres, Matthias (2024): Type 1 Myocardial Infarction in Patients With Acute Ischemic Stroke. In: JAMA Neurology, Bd. 81, Nr. 7: S. 703-711

Abstract

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.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin > Munich Cluster for Systems Neurology (SyNergy) ; Medizin > Institut für Schlaganfall- und Demenzforschung (ISD)
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 2168-6149
• Sprache: Englisch
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 390857198