[Acute coronary syndrome in acute stroke]
F Jansen1, G Nickenig1, G C Petzold2
1Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
Insights
Elevated troponin in stroke patients requires careful evaluation. Determining the cause, whether myocardial infarction or other cardiac issues, is crucial for appropriate treatment and preventing complications.
Area of Science:
- Cardiology
- Neurology
- Clinical Medicine
Background:
- Elevated troponin is common in acute stroke patients, often co-occurring with coronary artery disease.
- Troponin release can stem from acute thrombotic myocardial infarction or non-thrombotic neurocardiogenic causes.
- Unclear troponin etiology and bleeding risks complicate timely coronary diagnostics and therapy in stroke patients.
Purpose of the Study:
- To outline a diagnostic and therapeutic strategy for stroke patients presenting with elevated troponin levels.
- To address the clinical challenge of managing troponin elevation in the context of acute stroke.
Main Methods:
- Literature review to establish a diagnostic and therapeutic approach.
- Evaluation of clinical, laboratory, and electrocardiographic parameters to assess myocardial infarction probability.
- Consideration of coronary angiography/CT angiography and dual antiplatelet therapy based on bleeding risk.
Main Results:
- Initial assessment focuses on differentiating thrombotic myocardial infarction from other causes of troponin elevation.
- Coronary angiography/CT angiography is recommended for suspected myocardial infarction.
- Treatment strategies, including dual antiplatelet therapy or interventions like thrombus aspiration, are guided by intracranial bleeding risk.
Conclusions:
- A comprehensive diagnostic workup is essential for stroke patients with elevated troponin.
- Accurate diagnosis of myocardial infarction probability is key to preventing cardiac and neurological complications.
- Tailored therapeutic decisions are necessary to balance treatment efficacy and bleeding risk.
Background:
Elevated troponin levels are commonly found in patients with acute stroke and approximately 60 % of stroke patients suffer from an accompanying coronary artery disease. Troponin release can be caused either by an acute thrombotic myocardial infarction or by insufficient coronary perfusion due to neurocardiogenic causes like blood pressure or heart rate variability without thrombotic coronary occlusion. Due to the often unclear pathological cause of troponin release and the risk of secondary hemorrhage during dual antiplatelet therapy, the determination of the best time point for coronary diagnostics and therapy in stroke patients is a common challenge in clinical daily routine.
Materials And Methods:
Based on the current literature, we describe a potential diagnostic and therapeutic approach in stroke patients with increased troponin levels.
Results:
First, the probability of an acute thrombotic myocardial infarction should be evaluated based on clinical, laboratory, and electrocardiographic parameters. In case of suspected myocardial infarction, a diagnostic coronary angiography/CT angiography should be performed and dual antiplatelet therapy should be given depending on the intracranial bleeding risk. In patients with high risk of intracranial bleeding, thrombus aspiration and balloon dilatation should be considered.
Conclusion:
In patients with acute stroke and elevated troponin levels, a thorough diagnostic workup is necessary to estimate the probability for a thrombotic myocardial infarction and to prevent cardiac and neurologic complications.
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