[Acute coronary syndrome in acute stroke].
BACKGROUND
Elevated troponin levels are commonly found in patients with acute stroke and approximately 60 % of stroke patients suffer from an accompanying coronary artery disease. Troponin release can be caused either by an acute thrombotic myocardial infarction or by insufficient coronary perfusion due to neurocardiogenic causes like blood pressure or heart rate variability without thrombotic coronary occlusion. Due to the often unclear pathological cause of troponin release and the risk of secondary hemorrhage during dual antiplatelet therapy, the determination of the best time point for coronary diagnostics and therapy in stroke patients is a common challenge in clinical daily routine.


METHODS
Based on the current literature, we describe a potential diagnostic and therapeutic approach in stroke patients with increased troponin levels.


RESULTS
First, the probability of an acute thrombotic myocardial infarction should be evaluated based on clinical, laboratory, and electrocardiographic parameters. In case of suspected myocardial infarction, a diagnostic coronary angiography/CT angiography should be performed and dual antiplatelet therapy should be given depending on the intracranial bleeding risk. In patients with high risk of intracranial bleeding, thrombus aspiration and balloon dilatation should be considered.


CONCLUSIONS
In patients with acute stroke and elevated troponin levels, a thorough diagnostic workup is necessary to estimate the probability for a thrombotic myocardial infarction and to prevent cardiac and neurologic complications.
Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
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Jansen
Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
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Nickenig
Klinik für Neurologie, Universitätsklinikum Bonn, Bonn, Deutschland.
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Petzold
Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland. nwerner@uni-bonn.de.
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Werner
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy; D000465:Algorithms; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D015897:Comorbidity; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment; D020521:Stroke / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy; D014336:Troponin / Q000097:blood*
D010975:Platelet Aggregation Inhibitors; D014336:Troponin
Balloon dilation; Intracranial hemorrhages; Myocardial infarction; Platelet aggregation inhibitors; Troponin