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Elevated troponin levels are associated with higher mortality following intracerebral hemorrhage

From the Department of Neurology, Neurology/Neurosurgery Intensive Care Unit, Washington University, St. Louis, MO.

Address correspondence and reprint requests to Dr. Michael N. Diringer, Department of Neurology, Box 8111, 660 South Euclid Avenue, St. Louis, MO 63110; e-mail: diringerm{at}neuro.wustl.edu

Background: Elevated troponin levels are an independent indicator of poor outcome in ischemic stroke. The authors performed a retrospective study to ascertain whether elevated cardiac troponin I (cTnI) influences outcome from intracerebral hemorrhage (ICH).

Methods: Patients were included if they had a cTnI level measured and a head CT performed within 24 hours of presentation with a spontaneous ICH. Those with recent stroke, angina, or myocardial ischemia were excluded. CT scans were reviewed to determine the hematoma size, location, presence of intraventricular or subarachnoid hemorrhage, hydrocephalus, and midline shift.

Results: Of the 729 ICH patients admitted over 4 years, 235 were included in the analysis. Most exclusions were for medical reasons or because of lack of a CT. Mortality was higher in the 18% with a peak cTnI level > 0.4 ng/mL (58 vs 34%, p = 0.009) and having elevated cTnI was an independent predictor of in-hospital mortality (Exp [ß] 3.68, 95% CI 1.2 to 11.2, p = 0.023). Three patients (1.2%) died due to cardiac events, all of whom had an elevated cTnI level on admission.

Conclusions: Elevated cardiac troponin I (cTnI) values occur frequently in ICH and are independently associated with higher in-hospital mortality. Although cardiac causes of death were higher in those with elevated cTnI levels, due to its very low frequency (1.2%) this finding remains preliminary.

Supported by NIH (N535966).

Disclosure: Dr. Diringer receives consulting and speaking fees from Novo Nordisk. Dr. Hays reports no conflict of interest.

Received September 12, 2005. Accepted in final form January 25, 2006.

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