Annals of Neurology: High-sensitivity cardiac troponin, which can predict future adverse vascular events

Patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) are at high risk of recurrent vascular events
.

Some clinical prediction schemes, such as "age, blood pressure, clinical characteristics, duration of symptoms, diabetes " (ABCD2) scores have been proposed to guide the clinical triage of patients

Stroke Vascular Diabetes

Although it was originally for early shunting after TIA, some people believe that the higher the ABCD score, the greater the risk of recurring vascular events after ischemic stroke
.

However, the individual stratification of future vascular risks after cerebrovascular events is still limited, and individual risks may vary greatly

It is increasingly recognized that blood-based biomarkers may help provide individual risk estimates beyond conventional risk factors by capturing biologically relevant pathways
.

Blood-based biomarkers may help provide individual risk estimates beyond conventional risk factors by capturing biologically relevant pathways
.

Recent observations have emphasized the potential role of high-sensitivity cardiac troponin (hs-cTn) levels in this regard
.

Myocardial injury where hs-cTnT rises above the specific 99th percentile reference upper limit (URL) for detection is common after stroke and is associated with poor long-term prognosis

In the general population and in patients with atrial fibrillation, a higher level of hs-cTn thrombus embolism and major adverseThe increased risk of cardiovascular events (MACE) is associated
.

thrombusCardiovascular

However, in recent ischemic stroke or TIA patients, this association has not been well confirmed
.

Under normal circumstances, antithrombotic therapy and risk factor control are considered suitable for all post-stroke patients, but whether some patients can benefit from intensive secondary prevention measures is still unknown
.

prevention

The recently completed INSPiRE-TMS trial (INtensified Secondary Prevention intending a Reduction of recurrent Events after Transient ischaemic attack and Minor Stroke) showed that compared with conventional treatment, patients who were randomized to receive a multi-component secondary prevention support program had better risk factor control Significantly improved
.

However, this did not translate into a significant reduction in subsequent MACE in these patients
.

However, subgroup analysis suggests that patients with higher-risk ABCD2 scores may benefit from research interventions

Using the data of INSPiRE-TMS, Simon Hellwig and others of the University of Berlin in Germany explored:
1) Whether the presence of myocardial damage (hs-cTnT level higher than URL) is related to recurrent MACE in patients with minor stroke or TIA;
2) According to ABCD2 score, whether this association is maintained in patients who are considered to have lower or higher vascular risk;
3) Whether the effect of the multi-component support plan tested in INSPiRE-TMS is changed due to the level of hs-cTnT
.

INSPiRE-TMS is a randomized controlled trial that assigns patients with mild stroke or TIA to an intensive support plan or routine care
.

In this post-mortem analysis, the level of hs-cTnT (5th generation, Roche, 99th percentile reference upper limit [URL] 14ng/L) was used to classify participants

Among 889 patients (mean age 70 years, 37% women), 153 patients (17.

2%) had MACE during an average follow-up period of 3.
2 years

This association still exists after PSM (adjusted HR is 1.
76 [95%CI 1.
14-2.
72])
.

There is a significant interaction between the hs-cTnT and ABCD2 categories on the occurrence of MACE (pinteraction = 0.

This association still exists after PSM (adjusted HR is 1.

The important significance of this study lies in the discovery: Hs-cTnT level is related to the occurrence of MACE within three years after minor stroke or TIA, which may help identify high-risk groups, otherwise the risk is considered low based on the ABCD2 score
.
If confirmed in an independent validation study, this may require strengthening secondary prevention measures and cardiac diagnosis for stroke patients with elevated hs-cTnT
.

The Hs-cTnT level is related to the occurrence of MACE within three years after a minor stroke or TIA, which may help identify high-risk groups, otherwise the risk is considered low based on the ABCD2 score
.
diagnosis

Original source:
Hellwig S, Ihl T, Ganeshan R, et al.
Cardiac troponin and recurrent major vascular events after minor stroke or TIA.
_Ann Neurol_ .
Published online September 25, 2021:ana.
26225.
doi:10.
1002/ana.
26225

Cardiac troponin and recurrent major vascular events after minor stroke or TIA.
_Ann Neurol_

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