Abstract 17342: The Global Registry of Acute Coronary Events Risk Score Predicts Mortality in Patients With Acute Ischemic Stroke and Abnormal Serum Troponin
Introduction: Almost 20% of patients with acute ischemic stroke have abnormal serum troponin I (TnI) levels, which are associated with increased mortality. Previous studies provide limited evidence for further risk stratification in this population.
Hypothesis: We hypothesized that acute coronary syndrome risk scores would predict mortality after ischemic stroke in patients with elevated TnI.
Methods: Prospective database of 1718 acute ischemic stroke patients admitted to the University of Pittsburgh Medical Center from December 2008 to November 2010. We included 309 (18%) with TnI ≥0.1 ng/ml. Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk scores were calculated using chest X-ray to determine Killip class; TnI ≥0.5 ng/ml was used to define “positive biomarkers” based on prognostic value of this cut-off in prior studies of this population. We used Cox proportional-hazards models to determine the association of these risk scores with inpatient mortality after multivariable adjustment.
Results: Mean inpatient GRACE score was 130.0 +/- 35.1 and mean TIMI score was 3.05 +/- 1.20. Inpatient mortality was 38.0% with GRACE score <140 and 67.3% with GRACE score ≥140 (unadjusted HR 2.37, p <0.001). Inpatient GRACE score ≥140 was independently associated with mortality after multivariable adjustment (adjusted HR 1.74, p = 0.017). TIMI risk score was significantly associated with mortality in unadjusted analyses (HR 1.22, p = 0.003), but not after multivariable adjustment (HR 1.04, p = 0.69). Inpatient GRACE score was significantly associated with mortality after adjustment including TIMI risk score (HR 1.02, p <0.001). We observed a graded relationship between quintiles of GRACE score and mortality (Figure 1).
Conclusion: The inpatient GRACE risk score, but not the TIMI risk score, independently predicts mortality in patients with acute ischemic stroke and abnormal serum troponin.
Author Disclosures: J.C. Jentzer: None. O. Batal: None. Z. Dardari: None. M. Schmidhofer: None. M. Hammer: None. T. Jovin: None. V. Reddy: None.
- © 2016 by American Heart Association, Inc.