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Updated: May 12, 2026

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Type 1 Myocardial Infarction in Patients With Acute Ischemic Stroke

Christian H Nolte1,2,3,4, Regina von Rennenberg1,2,5, Simon Litmeier1,2,5

  • 1Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.

JAMA Neurology
|June 3, 2024
PubMed

Insights

Dynamic changes in high-sensitivity cardiac troponin (hs-cTn) do not indicate myocardial infarction (MI) in acute ischemic stroke patients. Very high hs-cTn levels, however, may suggest type 1 MI, warranting further investigation.

Area of Science:

  • Cardiology
  • Neurology
  • Biomarkers

Background:

  • Elevated high-sensitivity cardiac troponin (hs-cTn) is common in acute ischemic stroke (AIS) patients, correlating with poor outcomes.
  • The diagnostic and therapeutic significance of hs-cTn elevation in AIS remains unclear.

Purpose of the Study:

  • To identify factors indicating myocardial infarction (MI) in AIS patients with elevated hs-cTn.
  • To test the hypothesis that a dynamic hs-cTn change (>50%) signifies MI in AIS.

Main Methods:

  • Prospective, observational study across 26 German sites.
  • Included AIS patients with elevated hs-cTn on admission or significant hs-cTn change.
  • Standardized ECG, echocardiography, and coronary angiography used for MI diagnosis.

Main Results:

  • Of 247 patients, 51% had MI; 20% had type 1 MI.
  • Dynamic hs-cTn change was not associated with MI (OR 1.05; 95% CI 0.31-3.33).
  • High baseline hs-cTn values (5-10x upper limit of normal) independently predicted type 1 MI.

Conclusions:

  • Dynamic hs-cTn changes do not reliably identify MI in AIS patients.
  • Very high absolute hs-cTn levels are associated with type 1 MI.
  • Further research is needed to optimize coronary angiography selection in stroke patients.
Abstract

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