Predictive ability of cardiac biomarkers for early risk stratification and 3-month functional outcomes after reperfusion therapy in acute ischemic stroke

Objective This study aimed to determine the prognostic value of baseline serum cardiac biomarkers measured at emergency department admission in patients with acute ischemic stroke undergoing reperfusion therapy.Method This retrospective cohort study evaluated data from 433 AIS patients treated with intravenous thrombolysis (IVT), mechanical thrombectomy (MT), or combined therapy. Serum lactate dehydrogenase, creatine kinase, plasma N-terminal pro-brain natriuretic peptide, and high-sensitivity cardiac troponin T levels were analyzed. Stroke severity, functional outcomes, hemorrhagic transformation, and mortality were assessed. Continuous variables were evaluated using the Shapiro-Wilk test, Kruskal-Wallis ANOVA, and post-hoc pairwise comparisons. Diagnostic efficacy was calculated using ROC-AUC and the Youden Index. Independent risk factors were identified via Multivariate Logistic Regression analysis.Results High-sensitivity cTnT predicted functional prognosis at both discharge and 3 months, whereas LDH predicted outcomes exclusively at 3 months. Elevated CK and LDH levels correlated significantly with stroke etiology. An hs-cTnT value > 10.5 pg/mL independently increased the risk of poor discharge prognosis (OR: 1.725, p < 0.05). In multivariate logistic regression, age, baseline NIHSS, and hs-cTnT were independent risk factors for poor discharge outcomes. For 3-month mRS scores, the optimal prognostic cut-off values were > 200 U/L for LDH (p = 0.003) and >10.5 pg/mL for hs-cTnT (p = 0.007). In the final multivariate model, baseline NIHSS, stroke etiology, LDH (>200 U/L, OR: 1.845, p < 0.05), and hs-cTnT (>10.5 pg/mL, OR: 1.685, p < 0.05) emerged as independent risk factors for a poor 3-month prognosis.Conclusion Integrating admission cardiac biomarkers into clinical evaluation scores significantly enhances risk stratification and predictive accuracy in acute ischemic stroke management.