Cardiac troponin and recurrent major vascular events after minor stroke or TIA

Objective To investigate whether high-sensitivity cardiac troponin T (hs-cTnT) is associated with major adverse cardiovascular events (MACE) in patients with minor stroke or transient ischemic attack (TIA), and whether this association differs after risk stratification based on the "Age, Blood pressure, Clinical features, Duration of symptoms, Diabetes" (ABCD2 ) score. Methods INSPiRE-TMS was a randomized controlled trial allocating patients with minor stroke or TIA to an intensified support program or conventional care. In this post-hoc analysis, participants were categorized using hs-cTnT levels (5th Generation, Roche, 99th percentile upper reference limit [URL] 14ng/L). Vascular risk was stratified using the ABCD2 score (lower-risk:0-5 vs. higher-risk:6-7). Cox proportional hazard regression was performed using covariate adjustment and propensity score matching (PSM) for the association between hs-cTnT and MACE (stroke/non-fatal coronary event/vascular death). Results Among 889 patients (mean age 70 years, 37% female), MACE occurred in 153 patients (17.2%) during a mean follow-up of 3.2 years. Hs-cTnT was associated with MACE (9.3%/year>URL vs. 4.4%/year≤URL, adjusted HR 1.63 [95%CI 1.13-2.35], adjusted HR (Q4 vs.Q1 ) 2.57 [95%CI 1.35-4.97], adjusted HR (log-transformed) 2.31 [95%CI 1.37-3.89]). This association remained after PSM (adjusted HR 1.76 [95%CI 1.14-2.72]). There was a significant interaction between hs-cTnT and ABCD2 category for MACE occurrence (pinteraction =0.04). In the lower-risk category, MACE rate was 9.5%/year in patients with hs-cTnT>URL, which was higher than in those ≤URL (3.8%/year) and similar to the overall rate in the higher-risk category. Interpretation Hs-cTnT levels are associated with incident MACE within three years after minor stroke or TIA and may help to identify high-risk individuals otherwise deemed at lower-risk based on the ABCD2 score. If confirmed in independent validation studies, this might warrant intensified secondary prevention measures and cardiac diagnostics in stroke patients with elevated hs-cTnT. This article is protected by copyright. All rights reserved.