急性缺血性脑卒中患者高敏心肌肌钙蛋白T动态升高与神经功能转归的相关性OA

Objective:To investigate the association between in-hospital dynamic elevation of high-sensitivity cardiac troponin T(hs-cTnT)and early neurological deterioration(END)as well as 3-month functional outcomes in patients with acute ischemic stroke(AIS).Methods:Data of AIS patients who underwent two hs-cTnT measurements during hospitalization between March 2017 and November 2024 were extracted from the Comparison Influence to Prognosis of CTP and MRP in AIS Patients(CIPPIS)database(NCT03367286)for retrospective analysis.Patients were categorized into a dynamic elevation group and a non-elevation group based on whether their hs-cTnT increased by more than 20%from the baseline level.The incidences of END and 3-month functional independence were compared between the two groups.END was defined as a≥4-point increase in the National Institutes of Health Stroke Scale(NIHSS)score within 7 days of onset,and functional independence was defined as a modified Rankin Scale(mRS)score 0-2.Binary logistic regression was used to analyze the relationship between hs-cTnT dynamic elevation and the outcomes.Sensitivity analysis(excluding patients with acute myocardial infarction or severe renal dysfunction)and subgroup analyses were performed to assess the robustness of the findings.Results:A 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:0.47-0.97,P<0.05).The results were consistent in sensitivity analysis,and no significant interactions were observed across various subgroups(all interactions P>0.05).Conclusions:In patients with AIS,dynamic elevation of hs-cTnT is independently associated with an increased risk of END and poorer 3-month functional outcomes.This association may reflect the adverse impact of acute myocardial injury on stroke prognosis.