Key result
High versus low levels of high-sensitivity cardiac troponin were associated with an increased risk of incident stroke in the general population (HR 1.25; 95% CI 1.10-1.40).
Why the study?
The study was designed to estimate the risk of incident stroke based on hs-cTn levels in the general population, patients with atrial fibrillation, and patients with previous stroke.
Does high hs-cTn level predict an increased risk of incident stroke in the general population and patients with atrial fibrillation?
Meta-Analysis (n=96,702)
Does high hs-cTn level predict an increased risk of incident stroke in the general population and patients with atrial fibrillation?
Hazard Ratio: 1.25 (95% CI 1.1–1.4)
High-sensitivity cardiac troponin is a significant risk marker for incident stroke in both the general population and patients with atrial fibrillation.
Elevated hs-cTn may refine stroke risk stratification in AF and general populations; leaves open whether measurement alters prevention.
Background and Purpose- Our study aim was to estimate risk of incident stroke based on levels of hs-cTn (high-sensitivity cardiac troponin), a specific biomarker indicating myocardial injury, in the general population, patients with atrial fibrillation, and patients with previous stroke. Methods- Embase, PubMed, and Web of Science were searched until March 14, 2019 to identify relevant articles. Randomized controlled trials and cohort studies assessing the risk of incident stroke based on hs-cTn were eligible. Pooled adjusted hazard ratios including 95% CI were calculated using a random-effects model due to study heterogeneity per population, coding of hs-cTn (categorical/continuous data), per hs-cTn subunit (T or I), for low risk of bias, and for all-cause and ischemic stroke separately. Results- We included 17 articles with 96 702 participants. In studies conducted in the general population (n=12; 77 780 participants), the pooled adjusted hazard ratio for incident stroke was 1.25 (CI, 1.10-1.40) for high versus low hs-cTn (as defined by included studies) during an average follow-up of 1 to 20 years (median 10). When categorical data were used, this was increased to 1.58 (CI, 1.26-1.90). The results were robust when accounting for stroke classification (all-cause stroke/ischemic stroke), hs-cTn subunit, risk of bias, and coding of hs-cTn. In patients with atrial fibrillation (4 studies; 18 725 participants), the pooled adjusted hazard ratio for incident stroke was 1.95 (CI, 1.29-2.62) for high versus low hs-cTn. Due to lack of data (one study, 197 participants), no meta-analysis could be performed in patients with previous stroke. Conclusions- This meta-analysis suggests that hs-cTn can be regarded as a risk marker for incident stroke, with different effect size in different subgroups. More research about the association between hs-cTn and incident stroke in high-risk populations is needed, especially in patients with history of ischemic stroke.
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Broersen et al. (2020) conducted a meta-analysis in Risk of incident stroke (n=96,702). High-sensitivity cardiac troponin (hs-cTn) vs. Low hs-cTn was evaluated on Incident stroke in the general population (HR 1.25, 95% CI 1.10-1.40). High versus low levels of high-sensitivity cardiac troponin were associated with an increased risk of incident stroke in the general population (HR 1.25; 95% CI 1.10-1.40).
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