Coronary Angiographic Findings in Acute Ischemic Stroke Patients With Elevated Cardiac Troponin: The TRoponin ELevation in Acute Ischemic Stroke (TRELAS) Study
Background—A relevant proportion of patients with acute ischemic stroke (AIS) have elevated levels of cardiac troponins (cTn). However, the frequency of coronary ischemia as the cause of elevated cTn is unknown. The aim of our study was to analyze coronary vessel status in AIS patients with elevated cTn in comparison to patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS).
Methods and Results—Among 2,123 consecutive AIS patients prospectively screened at two tertiary hospitals, 13.7% had cTn elevation (>50ng/l). According to a pre-specified sample size estimation, 29 AIS patients (median age 76 [Q1-Q3: 70-82], 52% male) underwent conventional coronary angiography and were compared to age- and gender-matched patients with NSTE-ACS. The primary endpoint was presence of coronary culprit lesions on coronary angiograms as analysed by independent interventional cardiologists blinded for clinical data. Median cTn on presentation did not differ between patients with AIS or NSTE-ACS (95ng/l versus 94ng/l, p=0.70). Compared to patients with NSTE-ACS, AIS patients were less likely to have coronary culprit lesions (7/29 versus 23/29, p<0.001) or any obstructive coronary artery disease (CAD; 15/29 versus 25/29, p=0.02; median number of vessels with >50% stenosis 1 [Q1-Q3 0-2] versus 2 [Q1-Q3 1-3], p<0.01).
Conclusions—Coronary culprit lesions are significantly less frequent in AIS patients compared to age- and gender matched patients with NSTE-ACS despite similar baseline cTn levels. Half of all AIS patients had no angiographic evidence of CAD. Further studies are needed to clinically identify the minority of patients with AIS and angiographic evidence of a culprit lesion.
Clinical Trial Registration Information—www.clinicaltrials.gov. Identifier: NCT01263964.
- culprit artery
- ischemic stroke
- non—ST-segment elevation acute coronary syndrome
- coronary angiography
- Received July 16, 2015.
- Revision received January 22, 2016.
- Accepted January 28, 2016.