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Routine Troponin Measurements Are Unnecessary to Exclude Asymptomatic Coronary Events in Acute Ischemic Stroke
Farwa Ali1, Jimmy Young1, Alejandro A Rabinstein1
1Department of Neurology, Mayo Clinic, Rochester, Minnesota.
Insights
Routine troponin testing in acute ischemic stroke patients rarely indicates acute myocardial ischemia. Measurement should be based on clinical context, not universal protocol, to guide effective patient care.
Area of Science:
- Cardiology
- Neurology
- Clinical Diagnostics
Background:
- Recent stroke guidelines recommend serum troponin levels for all acute stroke patients.
- Evidence supporting the clinical utility of routine troponin measurements in acute stroke is lacking.
- This study investigates the clinical significance of troponin levels in acute ischemic stroke.
Purpose of the Study:
- To determine the clinical significance of measuring serum troponin levels in patients with acute ischemic stroke.
- To evaluate the causes and implications of elevated troponin levels in this patient population.
Main Methods:
- Retrospective review of 398 acute ischemic stroke patients (2010-2012).
- Analysis of serum troponin T levels measured during the study period.
- Correlation of troponin levels with patient demographics, comorbidities, and clinical outcomes.
Main Results:
- Serum troponin T was measured in 61.8% of patients.
- Elevated troponin levels were observed in 15.5% of patients, with only 1.6% showing a significant uptrend.
- Elevated troponin was rarely due to acute myocardial ischemia, often linked to iatrogenic causes (vasopressors) or comorbidities like chronic kidney disease and heart failure.
Conclusions:
- Serum troponin elevation in ischemic stroke patients is infrequently caused by acute myocardial ischemia.
- Iatrogenic factors, particularly vasopressor use, can lead to elevated troponin.
- Troponin levels should be measured judiciously based on clinical suspicion rather than routine screening in all stroke patients.
Background:
Obtaining serum troponin levels in every patient with acute stroke is recommended in recent stroke guidelines, but there is no evidence that these contribute positively to clinical care. We sought to determine the clinical significance of measuring troponin levels in acute ischemic stroke patients.
Methods:
We reviewed 398 consecutive patients with acute ischemic stroke at a large academic institution from 2010 to 2012. Troponin levels were measured as a result of protocol in place during part of the study period. The mean age was 70 years (standard deviation ±16 years) and 197 (49.5%) were men.
Results:
Chronic kidney disease was present in 78 (19.6%), coronary artery disease in 107 (26.9%), and atrial fibrillation in 107 (26.9%). Serum troponin T was measured in 246 of 398 patients (61.8%). Troponin was elevated (>.01 ng/mL) at any point in 38 of 246 patients (15.5%) and was elevated in 28 patients at all 3 measurements (11.3% of those with troponin measured). Only 4 of 246 patients (1.6%) had a significant uptrend. Two were iatrogenic in the setting of hemodynamic augmentation using vasopressors to maintain cerebral perfusion. One case was attributed to stroke and chronic kidney disease and another case to heart failure from inflammatory fibrocalcific mitral valvular heart disease.
Conclusions:
Serum troponin elevation in patients with ischemic stroke is not usually caused by clinically significant acute myocardial ischemia unless iatrogenic in the setting of vasopressor administration. Serum troponin levels should be measured judicially, based on clinical context, rather than routinely in all stroke patients.
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