Acute Myocardial Injury in Spontaneous Intracerebral Hemorrhage: A Secondary Observational Analysis of the FAST Trial
Background Acute myocardial injury is associated with poor outcomes in patients with acute ischemic stroke, but its prognostic significance in patients with spontaneous intracerebral hemorrhage remains unclear. We investigated whether acute myocardial injury and the direction of the cardiac troponin...
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Wiley
2024-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.035053 |
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| author | Michela Rosso Helena Stengl Jan F. Scheitz Jennifer Lewey Stephan A. Mayer Shadi Yaghi Scott E Kasner Jens Witsch |
| author_facet | Michela Rosso Helena Stengl Jan F. Scheitz Jennifer Lewey Stephan A. Mayer Shadi Yaghi Scott E Kasner Jens Witsch |
| author_sort | Michela Rosso |
| collection | DOAJ |
| description | Background Acute myocardial injury is associated with poor outcomes in patients with acute ischemic stroke, but its prognostic significance in patients with spontaneous intracerebral hemorrhage remains unclear. We investigated whether acute myocardial injury and the direction of the cardiac troponin I (cTnI) change (rising versus falling) affect post‐intracerebral hemorrhage outcomes. Methods and Results We re‐analyzed the FAST (Factor‐Seven‐for‐Acute‐Hemorrhagic‐Stroke) trial. Acute myocardial injury was defined as at least 1 cTnI value above the upper reference limit with a rise/fall of >20%. Logistic regression tested for associations (1) between acute myocardial injury (presence versus absence) and poor outcome (modified Rankin Scale 4–6) and mortality at 15 and 90 days; (2) among 3 groups (rising versus falling versus no acute myocardial injury) and outcomes. Among the 841 FAST participants, 785 patients were included. Acute myocardial injury was detected in 29% (n=227); 170 had rising cTnI. At 15 and 90 days, respectively, those with acute myocardial injury had higher odds of poor outcome (adjusted odds ratio) ([aOR] 2.3 [95% CI, 1.3–3.9]); and adjusted odds ratio 2.5 [95% CI, 1.6–3.9];, and higher odds of mortality (adjusted odds ratio 2.4 [95% CI, 1.4–4.3]; and adjusted odds ratio 2.2 [CI, 1.3–3.6]) than patients without. There was no interaction between FAST group assignment and myocardial injury, and associations between myocardial injury and outcomes were consistent across group assignments. Rising cTnI was associated with the highest risk of poor outcomes and mortality. Conclusions In this secondary analysis of the FAST trial, acute myocardial injury was common and associated with poor outcomes. The direction of the cTnI change might provide additional risk stratification after intracerebral hemorrhage. |
| format | Article |
| id | doaj-art-d7d7bd19eeb142cd99a1289da5aea47a |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-d7d7bd19eeb142cd99a1289da5aea47a2025-08-20T02:07:06ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-09-01131710.1161/JAHA.124.035053Acute Myocardial Injury in Spontaneous Intracerebral Hemorrhage: A Secondary Observational Analysis of the FAST TrialMichela Rosso0Helena Stengl1Jan F. Scheitz2Jennifer Lewey3Stephan A. Mayer4Shadi Yaghi5Scott E Kasner6Jens Witsch7Department of Neurology University of Pennsylvania Philadelphia PA USADepartment of Neurology and Center for Stroke Research Berlin Charité – Universitätsmedizin Berlin Berlin GermanyDepartment of Neurology and Center for Stroke Research Berlin Charité – Universitätsmedizin Berlin Berlin GermanyDivision of Cardiology, Department of Medicine University of Pennsylvania Philadelphia PA USADepartment of Neurology and Neurosurgery New York Medical College Valhalla NY USADepartment of Neurology Brown University Providence RI USADepartment of Neurology University of Pennsylvania Philadelphia PA USADepartment of Neurology University of Pennsylvania Philadelphia PA USABackground Acute myocardial injury is associated with poor outcomes in patients with acute ischemic stroke, but its prognostic significance in patients with spontaneous intracerebral hemorrhage remains unclear. We investigated whether acute myocardial injury and the direction of the cardiac troponin I (cTnI) change (rising versus falling) affect post‐intracerebral hemorrhage outcomes. Methods and Results We re‐analyzed the FAST (Factor‐Seven‐for‐Acute‐Hemorrhagic‐Stroke) trial. Acute myocardial injury was defined as at least 1 cTnI value above the upper reference limit with a rise/fall of >20%. Logistic regression tested for associations (1) between acute myocardial injury (presence versus absence) and poor outcome (modified Rankin Scale 4–6) and mortality at 15 and 90 days; (2) among 3 groups (rising versus falling versus no acute myocardial injury) and outcomes. Among the 841 FAST participants, 785 patients were included. Acute myocardial injury was detected in 29% (n=227); 170 had rising cTnI. At 15 and 90 days, respectively, those with acute myocardial injury had higher odds of poor outcome (adjusted odds ratio) ([aOR] 2.3 [95% CI, 1.3–3.9]); and adjusted odds ratio 2.5 [95% CI, 1.6–3.9];, and higher odds of mortality (adjusted odds ratio 2.4 [95% CI, 1.4–4.3]; and adjusted odds ratio 2.2 [CI, 1.3–3.6]) than patients without. There was no interaction between FAST group assignment and myocardial injury, and associations between myocardial injury and outcomes were consistent across group assignments. Rising cTnI was associated with the highest risk of poor outcomes and mortality. Conclusions In this secondary analysis of the FAST trial, acute myocardial injury was common and associated with poor outcomes. The direction of the cTnI change might provide additional risk stratification after intracerebral hemorrhage.https://www.ahajournals.org/doi/10.1161/JAHA.124.035053cardiac complicationscardiac troponindisabilityhemorrhagic strokemortality |
| spellingShingle | Michela Rosso Helena Stengl Jan F. Scheitz Jennifer Lewey Stephan A. Mayer Shadi Yaghi Scott E Kasner Jens Witsch Acute Myocardial Injury in Spontaneous Intracerebral Hemorrhage: A Secondary Observational Analysis of the FAST Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac complications cardiac troponin disability hemorrhagic stroke mortality |
| title | Acute Myocardial Injury in Spontaneous Intracerebral Hemorrhage: A Secondary Observational Analysis of the FAST Trial |
| title_full | Acute Myocardial Injury in Spontaneous Intracerebral Hemorrhage: A Secondary Observational Analysis of the FAST Trial |
| title_fullStr | Acute Myocardial Injury in Spontaneous Intracerebral Hemorrhage: A Secondary Observational Analysis of the FAST Trial |
| title_full_unstemmed | Acute Myocardial Injury in Spontaneous Intracerebral Hemorrhage: A Secondary Observational Analysis of the FAST Trial |
| title_short | Acute Myocardial Injury in Spontaneous Intracerebral Hemorrhage: A Secondary Observational Analysis of the FAST Trial |
| title_sort | acute myocardial injury in spontaneous intracerebral hemorrhage a secondary observational analysis of the fast trial |
| topic | cardiac complications cardiac troponin disability hemorrhagic stroke mortality |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.035053 |
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