Relationship of Cardiac Troponin and Creatine Kinase‑MB Fraction at Admission in Acute Ischemic Stroke and outcome in a Tertiary Hospital in Nigeria

Abstract

Background: Stroke has been a global burden, with increasing morbidity and mortality. Studies had reported elevated levels of serum cardiac troponin T (cTnT) and creatine kinase‑MB (CK‑MB) fraction in patients with acute ischemic stroke. Therefore, the aim of this study is to relate the serum levels of these biomarkers and outcome in acute ischemic stroke as seen in a tertiary hospital in Nigeria. Subjects and Methods: This study was conducted in Ahmadu Bello University Teaching Hospital, Zaria. One hundred acute ischemic stroke patients were recruited into the study from December 2013 to February 2015. Blood samples were collected within the first 24 h of admission for cTnT and CK‑MB concentration measurement using enzyme‑linked immunosorbent assay method. Patients’ outcome either dead or alive was recorded at 1 month (discharge) and at 24 months. Data were analyzed using SPSS version 20 and p < 0.05 was considered statistically significant. Results: The mean age of stroke patients was 59 years and 38% were women. Forty‑one percent of patients had a raised cTnT concentration with mean ± standard deviation (SD) of 108.31 ± 7.82 ng/ml while 59% had normal cTnT with mean ± SD of 79.91 ± 15.64 ng/ml (p = 0.000). Furthermore, 43% had raised CK‑MB concentration with mean ± SD of 35.01 ± 8.70 ng/ml and 57% had normal CK‑MB with mean ± SD of 17.41 ± 2.06 ng/ml (p = 0.000) on admission. Twenty‑two patients signed discharge against medical advice and left the hospital before 1 month. Twenty patients died in hospital within 1 month of admission with cTnT mean ± SD of 100.4 ± 15.5 ng/ml while the 58 patients who survived 1 month had a mean ± SD of admission cTnT of 88.2 ± 21.5 ng/ml (p = 0.009). Similarly, mean ± SD CK‑MB of dead patients was 32.6 ± 25.5 ng/ml compared to the live patients who had a mean ± SD of 25.5 ± 11.1 ng/ml (p = 0.04). After 24 months of follow‑up, a total of 31 patients died and their mean ± SD cTnT was found to be 97.0 ± 19.2 ng/ml while the live 47 patients had mean ± SD cTnT of 87.6 ± 21.1 ng/ml (p = 0.047). Furthermore, the mean ± SD of CK‑MB concentration of dead patients was 29.8 ± 13.0 ng/ml as against live patients who had 25.6 ± 11.2 ng/ml (p = 0.151). Conclusion: Admission serum cTnT concentration is a powerful predictor of mortality outcome in patients admitted with an acute ischemic stroke.