Association between dynamic elevation of high-sensitivity cardiac troponin T and functional outcomes in patients with acute ischemic stroke

ObjectiveTo investigate the association between in-hospital dynamic elevation of high-sensitivity cardiac troponin T (hs-cTnT) and both early neurological deterioration (END) and 3-month functional outcomes in patients with acute ischemic stroke (AIS).MethodsData of AIS patients who underwent two hs-cTnT measurements during hospitalization between March 2017 and November 2024 were extracted from the CIPPIS database for retrospective analysis. Based on whether hs-cTnT increased by more than 20% from the baseline level, patients were categorized into a dynamic elevation group and a non-elevation group. The incidences of END [defined as a ≥4-point increase in the National Institutes of Health Stroke Scale (NIHSS) score within 7 days of onset] and 3-month functional independence [defined as a modified Rankin Scale (mRS) score of 0-2] were compared between the two groups. Binary logistic regression was used to analyze the relationship between hs-cTnT dynamic elevation and the outcomes. Sensitivity analysis (after excluding patients with acute myocardial infarction or severe renal dysfunction) and subgroup analyses were performed to assess the robustness of the findings.ResultsA total of 1049 patients were included (median age 73 years). Among them, 406 patients (38.7%) were female, 226 patients (21.5%) exhibited hs-cTnT dynamic elevation. Compared with the non-elevation group, the dynamic elevation group had a significantly higher incidence of END (9.71% vs. 15.42%, P<0.05) and lower proportions of patients with 3-month mRS scores of 0-1 (37.75% vs. 26.57%, P<0.01), 0-2 (48.71% vs. 36.71%, P<0.01), and 0-3 (63.87% vs. 55.56%, P<0.05). The 3-month all-cause mortality was also higher in the dynamic elevation group (9.20% vs. 14.01%, P<0.05). After adjusting for confounders (including age, sex, baseline NIHSS score, baseline hs-cTnT level, TOAST classification, and reperfusion therapy), dynamic elevation of hs-cTnT remained independently associated with a higher risk of END (adjusted OR=1.73, 95%CI: 1.07-2.82, P<0.05) and lower odds of achieving 3-month mRS scores of 0-1 (adjusted OR=0.65, 95%CI: 0.44-0.96, P<0.05) and 0-2 (adjusted OR=0.67, 95%CI: 0.48-0.94, P<0.05). The results were consistent in sensitivity analysis, and no significant interactions were observed across various subgroups (all interaction P>0.05).ConclusionIn patients with AIS, in-hospital dynamic elevation of hs-cTnT is independently associated with an increased risk of early neurological deterioration and poorer 3-month functional outcomes. This association may reflect the adverse impact of acute myocardial injury on stroke prognosis.