Background and Purpose- Our study aim was to estimate risk of incident stroke based on levels of hs-cTn (high-sensitivity cardiac troponin), a specific biomarker indicating myocardial injury, in the general population, patients with atrial fibrillation, and patients with previous stroke. Methods- Embase, PubMed, and Web of Science were searched until March 14, 2019 to identify relevant articles. Randomized controlled trials and cohort studies assessing the risk of incident stroke based on hs-cTn were eligible. Pooled adjusted hazard ratios including 95% CI were calculated using a random-effects model due to study heterogeneity per population, coding of hs-cTn (categorical/continuous data), per hs-cTn subunit (T or I), for low risk of bias, and for all-cause and ischemic stroke separately. Results- We included 17 articles with 96 702 participants. In studies conducted in the general population (n=12; 77 780 participants), the pooled adjusted hazard ratio for incident stroke was 1.25 (CI, 1.10-1.40) for high versus low hs-cTn (as defined by included studies) during an average follow-up of 1 to 20 years (median 10). When categorical data were used, this was increased to 1.58 (CI, 1.26-1.90). The results were robust when accounting for stroke classification (all-cause stroke/ischemic stroke), hs-cTn subunit, risk of bias, and coding of hs-cTn. In patients with atrial fibrillation (4 studies; 18 725 participants), the pooled adjusted hazard ratio for incident stroke was 1.95 (CI, 1.29-2.62) for high versus low hs-cTn. Due to lack of data (one study, 197 participants), no meta-analysis could be performed in patients with previous stroke. Conclusions- This meta-analysis suggests that hs-cTn can be regarded as a risk marker for incident stroke, with different effect size in different subgroups. More research about the association between hs-cTn and incident stroke in high-risk populations is needed, especially in patients with history of ischemic stroke.

中文翻译：

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高灵敏性心肌肌钙蛋白与96 702人中风风险之间的关联：一项荟萃分析。

背景与目的-我们的研究目的是根据hs-cTn（高敏感性心脏肌钙蛋白）的水平来估计发生中风的风险，hs-cTn是一种指示心肌损伤的特殊生物标志物，适用于一般人群，房颤患者和先前中风。方法-搜寻Embase，PubMed和Web of Science直至2019年3月14日，以识别相关文章。符合hs-cTn评估中风风险的随机对照试验和队列研究均符合条件。由于每个人群的研究异质性，hs-cTn（分类/连续数据），每个hs-cTn亚基（T或I）的编码异质性，使用随机效应模型计算了包括95％CI的合并调整后的危险比。偏见，并分别针对全因和缺血性中风。结果-我们纳入了17篇文章，共有96702名参与者。在普通人群（n = 12； 77 780名参与者）中进行的研究中，高hs-cTn与低hs-cTn（由纳入研究定义）的合并调整后卒中危险比为1.25（CI，1.10-1.40）。平均随访1至20年（中位数10）。使用分类数据时，该数据增加到1.58（CI，1.26-1.90）。当考虑卒中分类（全因卒中/缺血性卒中），hs-cTn亚基，偏倚风险和hs-cTn编码时，结果是可靠的。在房颤患者（4个研究； 18 725名参与者）中，高hs-cTn与低hs-cTn的合并调整卒中危险比为1.95（CI，1.29-2.62）。由于缺乏数据（一项研究，197名参与者），先前有中风的患者无法进行荟萃分析。结论：这项荟萃分析表明，hs-cTn可以被视为发生中风的危险标志物，不同亚组的影响大小不同。在高危人群中，尤其是有缺血性卒中病史的患者中，需要进一步研究hs-cTn与卒中事件的相关性。