AUTHOR=Lin Fa , Chen Yu , He Qiheng , Zeng Chaofan , Zhang Chaoqi , Chen Xiaolin , Zhao Yuanli , Wang Shuo , Zhao Jizong 

TITLE=Prognostic Value of Elevated Cardiac Troponin I After Aneurysmal Subarachnoid Hemorrhage

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.677961

DOI=10.3389/fneur.2021.677961

ISSN=1664-2295

ABSTRACT=Object: Patients with aneurysmal subarachnoid hemorrhage (aSAH) have an increased incidence of cardiac events and short-term unfavorable neurological outcomes during the acute phase of bleeding. We studied whether troponin I elevation after ictus can predict future major adverse cardiac events (MACEs) and long-term neurological outcomes after two years. 
Methods:  Consecutive aSAH patients within three days of bleeding were eligible for review from a prospective observational cohort (ClinicalTrials.gov Identifier: NCT04785976). Potential predictors of future MACEs and unfavorable long-term neurological outcomes were calculated by Cox and logistic regression analyses. Additional Kaplan-Meier curves were performed. 
Results:  A total of 213 patients were enrolled with an average follow-up duration of 34.3 months. Individuals were divided into two groups, elevated cTnI group and unelevated cTnI group. Until the last available follow-up, 20 patients had died, with an overall all-cause mortality rate of 9.4% and an annual all-cause mortality rate of 3.8%. Patients with elevated cTnI had a significantly higher risk of future MACEs (10.6% vs 2.1%, p=0.024, 95% CI 1.256-23.875) and unfavorable neurological outcomes at discharge, 3-month, 1-year, 2-year and last follow-up (p=0.001, p<0.001, p=0.001, p<0.001, p<0.001, respectively). In the Cox analysis for future MACE, elevated cTnI was the only independent predictor (HR 5.980; 95% CI 1.428-25.407, p=0.014). In the multivariable logistic analysis for unfavorable neurological outcomes, peak cTnI was significant (OR 2.951; 95%CI 1.376-6.323; p=0.005). Kaplan-Meier analysis indicated that the elevated cTnI was correlated with future MACE (log-rank test, p=0.007) and subsequent death (log-rank test, p=0.004). 
Conclusion:  CTnI elevation after aSAH could powerfully predict future MACEs and unfavorable neurological outcomes.