FIB-4 Index, Systemic Inflammation, and Troponin Trajectory After Endovascular Thrombectomy in Older Patients with Large-Vessel Occlusion Stroke

Background: Stroke–heart syndrome affects prognosis after large-vessel occlusion acute ischemic stroke (LVO-AIS). The Fibrosis-4 (FIB-4) index may reflect metabolic vulnerability, but its association with post-stroke myocardial injury and the modifying role of systemic inflammation remain unclear. Methods: This retrospective single-center cohort included 448 consecutive patients aged ≥ 60 years with anterior-circulation LVO-AIS treated with endovascular thrombectomy. Cardiac troponin I was measured at admission and 48 hours after admission. Troponin trajectory was classified as no myocardial injury, non-dynamic myocardial injury, or dynamic myocardial injury. Ordinal logistic regression assessed associations of FIB-4 and C-reactive protein (CRP) with troponin trajectory. Binary logistic regression assessed 90-day mortality. Results: Among 448 patients, 255 had no myocardial injury, 35 had non-dynamic myocardial injury, and 158 had dynamic myocardial injury. In fully adjusted models, intermediate and high FIB-4 were associated with more severe troponin trajectory compared with low FIB-4 odds ratio (OR) 2.04, 95% confidence interval (CI) 1.18– 3.59; and OR 3.14, 95% CI 1.59– 6.30, respectively. Elevated CRP was also associated with more severe troponin trajectory (OR 2.91, 95% CI 1.86– 4.59). The association between high FIB-4 and troponin trajectory differed by CRP status (P for interaction = 0.019), being significant among patients with CRP ≥ 5 mg/L (OR 3.40, 95% CI 1.49– 7.76). Dynamic myocardial injury was associated with 90-day mortality (OR 5.08, 95% CI 2.43– 11.21). Conclusion: Higher FIB-4 and elevated CRP were associated with more severe troponin trajectory. Systemic inflammation may modify the FIB-4–myocardial injury association, and dynamic myocardial injury identified patients at increased mortality risk. Keywords: acute ischemic stroke, endovascular thrombectomy, fib-4 index, stroke-heart syndrome, C-reactive protein