BMJ 2000;320:1502-1504 ( 3 June )

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Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study

P James, medical registrar, ^a C J Ellis, cardiologist, ^b R M L Whitlock, clinical physiologist, ^c A R McNeil, clinical head, ^d J Henley, director of general medicine, ^a N E Anderson, associate professor of neurology. ^b

^a Department of General Medicine, Auckland Hospital, Grafton, Auckland 1000, New Zealand, ^b Department of Medicine, Auckland Hospital, Grafton, ^c Department of Physiology, Green Lane Hospital, Green Lane West, Auckland 1003, New Zealand, ^d Department of Chemical Pathology, Auckland Hospital, Grafton

Correspondence to: C J Ellis, Department of Medicine, 4th Floor, Auckland Hospital, Grafton, Auckland 1001, New Zealand cj.ellis{at}auckland.ac.nz

Objective: To assess whether a raised serum troponin T concentration would be an independent predictor of death in patients with an acute ischaemic stroke.
Design: Observational study.
Setting: Auckland Hospital, Auckland, New Zealand.
Subjects: All 181 patients with an acute ischaemic stroke admitted over nine months in 1997-8, from a total of 8057 patients admitted to the acute medical service.
Main outcome measures: Blood samples for measuring troponin T concentration were collected 12-72 hours after admission; other variables previously associated with severity of stroke were also recorded and assessed as independent predictors of inpatient mortality.
Results: Troponin T concentration was raised (>0.1 µg/l) in 17% (30) of patients admitted with an acute ischaemic stroke. Thirty one patients died in hospital (12/30 (40%) patients with a raised troponin T concentration v 19/151 (13%) patients with a normal concentration (relative risk 3.2 (95% confidence 1.7 to 5.8; P=0.0025)). Of 17 possible predictors of death, assessed in a multivariate stepwise model, only a raised troponin T concentration (P=0.0002), age (P=0.0008), and an altered level of consciousness at presentation (P=0.0074) independently predicted an adverse outcome.
Conclusions: Serum troponin T concentration at hospital admission is a powerful predictor of mortality in patients admitted with an acute ischaemic stroke.

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