ABSTRACT
BACKGROUND@#There is a complex relationship between coronary artery disease and stroke. Troponin I has been investigated for its potential as a prognostic biomarker in determining outcome and mortality after an acute cerebrovascular insult such as an ischemia. Several studies have been done mostly in Western countries leaving very little data for patients of Asian/Southeast Asian descent. Its implications in the prognosis and management of acute ischemic stroke may guide clinicians in rendering the most suitable care for their patients. @*OBJECTIVE@#This study aims to identify the impact of serum troponin I levels on short-term functional outcome after an acute ischemic cerebrovascular event. It also intends to evaluate the role of cardiac troponin I in identifying the prognosis and in-hospital mortality among patients with acute ischemic stroke.@*METHODS@#A prospective cohort study was done from August 2019 to February 2020 including 65 adult acute ischemic stroke patients (35 males and 30 females) coming to consult within 48 hours from ictus. Baseline electrocardiogram was done. Patients without evidence of an acute ACS and other cardiac diseases were included. Blood samples for determination of serum troponin I were collected. Patients were monitored for development of complications and incidence of in-hospital mortality. Sixty days from onset, short-term functional outcome was assessed by determining change in NIHSS score. Modified Rankin Scale (mRS) was used to assess degree of disability on follow-up. @*RESULTS@#Out of 65 patients initially enrolled, 23 (35.38%) had abnormally elevated troponin I. Patients with history of previous stroke and higher NIHSS scores on admission tend to have elevated troponin I. Patients with elevated troponin I had worse short-term functional outcome and were dependent in performing daily activities. This study did not demonstrate a predictive value of elevated troponin I for in-hospital mortality. @*CONCLUSION@#In patients with acute ischemic stroke, elevation of serum TnI has been observed even in the absence of a definite clinical acute coronary syndrome. Presence of previous stroke and more severe neurologic deficits has been shown to be related to elevations in TnI. This elevation in TnI, in turn, is associated with poor short-term outcome limiting patients’ functionality and independence. Managing these patients necessitate aggressive but judicious use of different diagnostic and treatment modalities to prevent adverse coronary events. These events are likely to be prevented when early recognition and proper management has been provided.
ABSTRACT
Background & Objective: Currentlythere is limitedintervention for acute ischemic stroke. Recombinant tissue plasminogen activator (rTPA) has been approved for immediate recanalization after a steno-occlusive lesion of cerebral vessels. rTPA has shown its efficacy and safety from several clinical trials. The present study reports our experience with intravenous rTPA from several centers in the Philippines.Method:This is a retrospective cohort study consisting of 157 patients who qualified to receive rTPA following the NINDS trial inclusion and exclusion criteria. The primary outcome is in-hospital and 3-months mortality. Other outcome measures were determined: intracranial hemorrhage secondary to hemorrhagic conversion and functional outcome as measured by modified Rankin Scale. Additionally, standard dose (0.9mg/kg) was compared to low dose (0.6mg/kg) of rTPA in terms of mortality, intracranial bleeding and functional outcome.Results:The in-hospital mortality was seen in 23 (14.6%) and total death within 3 months was 18.3%. Independent patient (mRS 0-2) was seen in 69 (51.1%) at discharge and 95 (73.1%) at 3 months. Intracranial bleeding due to asymptomatic hemorrhagic transformation occurred in 39 (24.8%) and symptomatic hemorrhagic transformation was seen in 19 (12.1%).Conclusion: Comparing our results with SITS-MOST and Cochrane collaborations, our data showed that we have more independent patients however death and intracranial bleeding was noted to be high in our cohort of patients. Additionally, the study showed more independent patients in the low dose group.
