Coronary Angiographic Findings in Acute Ischemic Stroke Patients With Elevated Cardiac Troponin

Mochmann, Hans‐Christian; Scheitz, Jan F.; Petzold, Gabor C.; Hæusler, Karl Georg; Audebert, Heinrich J.; Laufs, Ulrich; Schneider, Christine; Landmesser, Ulf; Werner, Nikos; Endres, Matthias; Witzenbichler, Bernhard; Nolte, Christian H.

doi:10.1161/circulationaha.115.018547

Cited by 109 publications

(95 citation statements)

References 45 publications

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“…In contrast, readmission rates for ACS during the follow-up of patients diagnosed with type 2 MI and NIMI are lower than those for patients with type 1 MI, which suggests that a high proportion of these patients do not present with significant coronary lesions,27 28 a finding that should be investigated in future studies.…”

Section: Discussionmentioning

confidence: 93%

Outcomes with type 2 myocardial infarction compared with non-ischaemic myocardial injury

Cediel

González‐Del‐Hoyo

Carrasquer

et al. 2016

Heart

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Patients with type 2 MI and NIMI were older, with higher proportion of women and more comorbidities than patients with type 1 MI. Absolute mortality and the adjusted risk for all-cause mortality in both groups were significantly higher than that of patients with type 1 MI (39.7%, HR: 1.41 95% CI 1.02 to 1.94, p=0.038 and 40.0%, HR: 1.54 95% CI 1.16 to 2.04, p=0.002, respectively). Patients with type 2 MI and NIMI tended to present more readmissions due to heart failure (16.5%, HR: 1.55 95% CI 0.87 to 2.76, p=0.133 and 12.3%, HR: 1.15 95% CI 0.70 to 1.90, p=0.580) and less readmission rates due to acute coronary syndrome (ACS) than patients with type 1 MI (2.1%, HR: 0.11 95% CI 0.04 to 0.31, p<0.001 and 4.3%, HR: 0.22 95% CI 0.12 to 0.41, p<0.001), CONCLUSIONS: Patients diagnosed with type 2 MI and NIMI have higher rates of mortality and lower readmission rates for ACS compared with patients with type 1 MI.

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Section: Discussionmentioning

confidence: 93%

Outcomes with type 2 myocardial infarction compared with non-ischaemic myocardial injury

Cediel

González‐Del‐Hoyo

Carrasquer

et al. 2016

Heart

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“…The recent TRELAS study found 24% of 29 AIS patients with hypertroponinemia had culprit lesions on coronary angiography, and 21% underwent mechanical revascularization. 30 . The number of culprit lesions was significantly lower than matched controls with AMI.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Positive Troponin and Echocardiogram Findings and Association With Mortality in Acute Ischemic Stroke

Wrigley

Khoury

Eckerle

et al. 2017

Stroke

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Background and Purpose Acute ischemic stroke (AIS) patients may have raised serum troponin (cTn) levels on admission, although it is unclear what prognostic implications this has, and whether elevated levels are associated with cardiac causes of stroke or structural cardiac disease as seen on echocardiogram. We investigated the positivity of cTn and echocardiogram testing within a large biracial AIS population, and any association with post stroke mortality. Methods Within a catchment area of 1.3 million we screened ED admissions from 2010 using ICD-9 discharge codes 430–436 and ascertained all physician-confirmed AIS cases by retrospective chart review. Hypertroponinemia was defined as elevation in cTn above the standard 99th percentile. Multiple logistic regression was performed, controlling for stroke severity, history of cardiac disease and all other stroke risk factors. Results Of 1999 AIS cases, 1706 (85.3%) had a cTn drawn and 1590 (79.5%) had echocardiograms. Hypertroponinemia occurred in 353/1706 (20.7%). 160/1590 (10.1%) had echocardiogram findings of interest. Among 1377 who had both tests performed, hypertroponinemia was independently associated with echocardiogram findings (OR 2.9 95% CI 2–4.2). When concurrent myocardial infarctions (MI, 3.5%) were excluded, hypertroponinemia was also associated with increased mortality at 1 year (35%, OR 3.45 95% CI 2.1–5.6) and 3 years (60%, OR 2.91 95% CI 2.06–4.11). Conclusions Hypertroponinemia in the context of AIS without concurrent MI was associated with structural cardiac disease and long-term mortality. Prospective studies are needed to determine if further cardiac evaluation might improve the long-term mortality rates seen in this group.

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“…In addition, a massive catecholamine exposure may also lead to ischemic myocardial injury via coronary vasoconstriction or tachyarrhythmia especially in those with preexisting coronary artery disease (type 2 MI). The frequency of concomitant type 1 MI is unclear, but compared with age-and sex-matched patients with non ST-segment elevation ACS, patients with ischemic stroke were less likely to have coronary culprit lesions (7 of 29 vs 23 of 29; P Ͻ0.001) despite similarly increased cardiac troponin concentrations (46 ). Half of all stroke patients had no angiographic evidence of coronary artery disease at all in that study.…”

Section: Strokementioning

confidence: 85%

Application of Cardiac Troponin in Cardiovascular Diseases Other Than Acute Coronary Syndrome

Eggers¹,

Lindahl

2017

Clinical Chemistry

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BACKGROUND Increased cardiac troponin concentrations in acute coronary syndrome (ACS) identify patients with ongoing cardiomyocyte necrosis who are at increased risk. However, with the use of more precise assays, cardiac troponin increases are commonly noted in other cardiovascular conditions as well. This has generated interest in the use of cardiac troponin for prognostic assessment and clinical management of these patients. In this review, we have summarized the data from studies investigating the implications of cardiac troponin concentrations in various acute and chronic conditions beyond ACS, i.e., heart failure, myocarditis, Takotsubo cardiomyopathy, aortic dissection, supraventricular arrhythmias, valve disease, pulmonary arterial hypertension, stroke, and in the perioperative setting. CONTENT Cardiac troponin concentrations are often detectable and frankly increased in non-ACS conditions, in particular when measured with high-sensitivity (hs) assays. With the exception of myocarditis and Takotsubo cardiomyopathy, cardiac troponin concentrations carry strong prognostic information, mainly with respect to mortality, or incipient and/or worsening heart failure. Studies investigating the prognostic benefit associated with cardiac troponin–guided treatments however, are almost lacking and the potential role of cardiac troponin in the management of non-ACS conditions is not defined. SUMMARY Increased cardiac troponin indicates increased risk for adverse outcome in patients with various cardiovascular conditions beyond ACS. Routine measurement of cardiac troponin concentrations can however, not be generally recommended unless there is a suspicion of ACS. Nonetheless, any finding of an increased cardiac troponin concentration in a patient without ACS should at least prompt the search for possible underlying conditions and these should be managed meticulously according to current guidelines to improve outcome.

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Coronary Angiographic Findings in Acute Ischemic Stroke Patients With Elevated Cardiac Troponin

Abstract: Background-A relevant proportion of patients with acute ischemic stroke (AIS) have elevated levels of cardiac troponins (cTn). However, the frequency of coronary ischemia as the cause of elevated cTn is unknown.

Cited by 109 publications

References 45 publications

Outcomes with type 2 myocardial infarction compared with non-ischaemic myocardial injury

Outcomes with type 2 myocardial infarction compared with non-ischaemic myocardial injury

Prevalence of Positive Troponin and Echocardiogram Findings and Association With Mortality in Acute Ischemic Stroke

Application of Cardiac Troponin in Cardiovascular Diseases Other Than Acute Coronary Syndrome

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