[Acute coronary syndrome in acute stroke]

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.