Troponin T in Prediction of Culprit Lesion Coronary Artery Disease and 1-Year Major Adverse Cerebral and Cardiovascular
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ORIGINAL ARTICLE
Troponin T in Prediction of Culprit Lesion Coronary Artery Disease and 1-Year Major Adverse Cerebral and Cardiovascular Events in Patients with Acute Stroke Tobias Zeus 1 & Ulrike Ketterer 1 & Daniela Leuf 1 & Lisa Dannenberg 1 & Rabea Wagstaff 1 & Florian Bönner 1 & Michael Gliem 2 & Sebastian Jander 2 & Malte Kelm 1 & Amin Polzin 1
Received: 25 November 2015 / Revised: 7 January 2016 / Accepted: 10 February 2016 / Published online: 22 February 2016 # Springer Science+Business Media New York 2016
Abstract Troponin T (TnT) elevation above the 99th percentile upper reference limit (URL) is considered diagnostic of acute myocardial infarction (MI). Non-specific increases of TnT are frequent in acute stroke patients. However, in these patients, correct diagnosis of MI is crucial because the antithrombotic medications used to treat acute MI might be harmful and produce intracranial bleeding. In this study, we aimed to associate enhanced TnT levels defined by different cutoff values with occurrence of culprit lesion coronary artery disease (CAD) as well as 1-year major adverse cerebral and cardiovascular events (MACCEs). In this cohort study, we investigated 84 consecutive patients with acute ischemic stroke and concomitant MI. TnT levels were measured using a fourthgeneration TnT assay. The incidence of culprit lesion CAD was determined by coronary angiography. MACCEs were recorded during 1-year follow-up. Culprit lesion CAD occurred in 55 % of patients, and 1-year MACCE in 37 %. TnT levels above the manufacturers’ provided 99th URL (TnT > 0.01) were not associated with culprit lesion CAD (relative risk [RR], 1.3; 95 % confidence interval [CI] 0.96–1.8; P = 0.09). Slightly increased cutoff level (TnT > 0.03) increased specificity and was associated with culprit lesion CAD without decreasing sensitivity (RR, 1.5; 95 % CI 1.1–2.2; P = 0.021) and
* Amin Polzin [email protected]
1
Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany
2
Department of Neurology, Heinrich Heine University, Dusseldorf, Germany
1-year MACCE (RR, 1.7; 95 % CI 1.3–2.3; P < 0.001). Slightly increasement of the TnT cutoff level predicted MACCEs and is superior in prediction of culprit lesion CAD in stroke patients without being less sensitive. This finding has to be confirmed in large-scale clinical trials. Keywords MACCE . Myocardial infarction . ROC . Stroke . Troponin
Abbreviations CAD Coronary artery disease MACCE Major adverse cerebral and cardiovascular event MI Myocardial infarction TIA Transient ischemic attack TnT Troponin T
Introduction Acute myocardial infarction (MI) is a leading cause of death worldwide. Cardiac biomarkers above the 99th percentile upper reference limit (URL) plus clinical symptoms of ischemia and/or particular electrocardiographic changes diagnose MI. The preferred cardiac biomarker is troponin. It is highly sensitive and specific for myocardial tissue [1]. The discriminatory cutoff value above the
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