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

 Since you don't want any major adverse cardiovascular events after your stroke you'll just have to wait to have your stroke until after your doctors and stroke hospital have initiated the research and come up with EXACT STROKE PROTOCOLS TO PREVENT THAT.  Your responsibility is to wait until then. You can't make any assumption that your stroke hospital can properly treat any type of stroke that comes in until they have defined protocols for all types. NOT GUIDELINES, guidelines are mostly worthless. The 17.2% occurrence rate is too high to not have any protocols addressing that. I wouldn't accept that risk from any medical procedure.

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

Simon Hellwig MD, MSc, Thomas Ihl MD, Ramanan Ganeshan MD, Inga Laumeier MD, Michael Ahmadi MD, Maureen Steinicke MD, Joachim E. Weber MD, Matthias Endres MD, … See all authors

First published: 25 September 2021

https://doi.org/10.1002/ana.26225

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/ana.26225.

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Abstract

Objective

To investigate whether high-sensitivity cardiac troponin T (hs-cTnT) is associated with major adverse cardiovascular events (MACE) in patients with minor stroke or transient ischemic attack (TIA), and whether this association differs after risk stratification based on the “Age, Blood pressure, Clinical features, Duration of symptoms, Diabetes” (ABCD²) score.

Methods

INSPiRE-TMS was a randomized controlled trial allocating patients with minor stroke or TIA to an intensified support program or conventional care. In this post-hoc analysis, participants were categorized using hs-cTnT levels (5^th Generation, Roche, 99^th percentile upper reference limit [URL] 14ng/L). Vascular risk was stratified using the ABCD² score (lower-risk:0-5 vs. higher-risk:6-7). Cox proportional hazard regression was performed using covariate adjustment and propensity score matching (PSM) for the association between hs-cTnT and MACE (stroke/non-fatal coronary event/vascular death).

Results

Among 889 patients (mean age 70 years, 37% female), MACE occurred in 153 patients (17.2%) during a mean follow-up of 3.2 years. Hs-cTnT was associated with MACE (9.3%/year>URL vs. 4.4%/year≤URL, adjusted HR 1.63 [95%CI 1.13-2.35], adjusted HR (Q₄ vs.Q₁) 2.57 [95%CI 1.35-4.97], adjusted HR (log-transformed) 2.31 [95%CI 1.37-3.89]). This association remained after PSM (adjusted HR 1.76 [95%CI 1.14-2.72]). There was a significant interaction between hs-cTnT and ABCD² category for MACE occurrence (p_interaction=0.04). In the lower-risk category, MACE rate was 9.5%/year in patients with hs-cTnT>URL, which was higher than in those ≤URL (3.8%/year) and similar to the overall rate in the higher-risk category.

Interpretation

Hs-cTnT levels are associated with incident MACE within three years after minor stroke or TIA and may help to identify high-risk individuals otherwise deemed at lower-risk based on the ABCD² score. If confirmed in independent validation studies, this might warrant intensified secondary prevention measures and cardiac diagnostics in stroke patients with elevated hs-cTnT.

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