Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study

Abstract

Objective: To assess whether a raised serum troponin T concentration would be an independent predictor of death in patients with an acute ischaemic stroke.

Design: Observational study.

Setting: Auckland Hospital, Auckland, New Zealand.

Subjects: All 181 patients with an acute ischaemic stroke admitted over nine months in 1997-8, from a total of 8057 patients admitted to the acute medical service.

Main outcome measures: Blood samples for measuring troponin T concentration were collected 12-72 hours after admission; other variables previously associated with severity of stroke were also recorded and assessed as independent predictors of inpatient mortality.

Results: Troponin T concentration was raised (>0.1 microgram/l) in 17% (30) of patients admitted with an acute ischaemic stroke. Thirty one patients died in hospital (12/30 (40%) patients with a raised troponin T concentration v 19/151 (13%) patients with a normal concentration (relative risk 3.2 (95% confidence 1.7 to 5. 8; P=0.0025)). Of 17 possible predictors of death, assessed in a multivariate stepwise model, only a raised troponin T concentration (P=0.0002), age (P=0.0008), and an altered level of consciousness at presentation (P=0.0074) independently predicted an adverse outcome.

Conclusions: Serum troponin T concentration at hospital admission is a powerful predictor of mortality in patients admitted with an acute ischaemic stroke.

Figure

Actuarial survival after admission of 181 patients (151 with normal concentration of troponin T; 30 with raised troponin) to hospital with acute stroke (error bars show 95% confidence intervals). Numbers indicate numbers of patients still at risk in hospital (that is, excluding those who have died and those who have recovered and left hospital)