Clinical Characteristics, Management, and Outcomes of Suspected Poststroke Acute Coronary Syndrome
Sylvia Marie Biso1, Marvin Lu1, Toni Anne De Venecia1
1Department of Medicine, Einstein Medical Center, 5401 Old York Road, Suite 363, Philadelphia, PA 19141, USA.
Insights
Acute coronary syndrome (ACS) following stroke is common. Elevated troponin levels predict mortality, while optimal medical therapy shows similar outcomes to interventions like PCI and/or CABG for poststroke ACS patients.
Area of Science:
- Cardiology
- Neurology
- Critical Care Medicine
Background:
- Acute coronary syndrome (ACS) is a significant complication of acute ischemic stroke.
- Poststroke ACS contributes to increased patient morbidity and mortality.
- Limited literature exists on the burden of poststroke ACS.
Purpose of the Study:
- To analyze clinical characteristics, cardiac evaluation, and management of patients with suspected poststroke ACS.
- To determine associations between these factors and inpatient mortality.
- To assess the impact on 1-year all-cause mortality.
Main Methods:
- Single-center, retrospective study design.
- Comparison of clinical data, cardiac assessments, and treatment strategies.
- Statistical analysis of associations with mortality outcomes.
Main Results:
- 82 patients studied; 32% presented with chest pain, 88% with ischemic ECG changes.
- Medical management group (older, lower troponin, shorter stay) compared to stent/CABG group.
- Higher troponin levels significantly correlated with 1-year all-cause mortality.
Conclusions:
- Age and troponin levels are key factors in clinical decision-making for suspected poststroke ACS.
- Troponin levels significantly predict 1-year all-cause mortality.
- Optimal medical therapy demonstrated comparable inpatient and 1-year mortality rates to PCI and/or CABG.
Background:
Acute coronary syndrome (ACS) can complicate acute ischemic stroke, causing significant morbidity and mortality. To date, literatures that describe poststroke acute coronary syndrome and its morbidity and mortality burden are lacking.
Methods:
This is a single center, retrospective study where clinical characteristics, cardiac evaluation, and management of patients with suspected poststroke ACS were compared and analyzed for their association with inpatient mortality and 1-year all-cause mortality.
Results:
Of the 82 patients, 32% had chest pain and 88% had ischemic ECG changes; mean peak troponin level was 18, and mean ejection fraction was 40%. The medical management group had older individuals (73 versus 67 years, p < 0.05), lower mean peak troponin levels (12 versus 49, p < 0.05), and lower mean length of stay (12 versus 25 days, p < 0.05) compared to those who underwent stent or CABG. Troponin levels were significantly associated with 1-year all-cause mortality.
Conclusion:
Age and troponin level appear to play a role in the current clinical decision making for patient with suspected poststroke ACS. Troponin level appears to significantly correlate with 1-year all-cause mortality. In the management of poststroke acute coronary syndrome, optimal medical therapy had similar inpatient and all-cause mortality compared to PCI and/or CABG.
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