title: Coronary Angiographic Findings in Acute Ischemic Stroke Patients With Elevated Cardiac Troponin: The Troponin Elevation in Acute Ischemic Stroke (TRELAS) Study.
abstract: 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 compared with patients presenting with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS).
  
  
  RESULTS
  Among 2123 consecutive patients with AIS prospectively screened at 2 tertiary hospitals, 13.7% had cTn elevation (>50 ng/L). According to a prespecified sample size estimation, 29 patients with AIS (median age, 76 years [first-third quartiles, 70-82 years]; 52% male) underwent conventional coronary angiography and were compared with age- and sex-matched patients with NSTE-ACS. The primary end point was presence of coronary culprit lesions on coronary angiograms as analyzed by independent interventional cardiologists blinded for clinical data. Median cTn on presentation did not differ between patients with AIS or NSTE-ACS (95 versus 94 ng/L; P=0.70). Compared with patients with NSTE-ACS, patients with AIS were less likely to have coronary culprit lesions (7 of 29 versus 23 of 29; P<0.001) or any obstructive coronary artery disease (15 of 29 versus 25 of 29; P=0.02; median number of vessels with >50% stenosis, 1 [first-third quartiles, 0-2] versus 2 [first-third quartiles, 1-3]; P<0.01).
  
  
  CONCLUSIONS
  Coronary culprit lesions are significantly less frequent in AIS patients compared with age- and sex-matched patients with NSTE-ACS despite similar baseline cTn levels. Half of all AIS patients had no angiographic evidence of coronary artery disease. Further studies are needed to clinically identify the minority of patients with AIS and angiographic evidence of a culprit lesion.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01263964.
authors.affiliation: From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.).
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Mochmann
authors.affiliation: From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.).
authors.forename: Jan F
authors.initials: JF
authors.lastname: Scheitz
authors.affiliation: From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.).
authors.forename: Gabor C
authors.initials: GC
authors.lastname: Petzold
authors.affiliation: From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.).
authors.forename: Karl Georg
authors.initials: KG
authors.lastname: Haeusler
authors.affiliation: From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.).
authors.forename: Heinrich J
authors.initials: HJ
authors.lastname: Audebert
authors.affiliation: From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.).
authors.forename: Ulrich
authors.initials: U
authors.lastname: Laufs
authors.affiliation: From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.).
authors.forename: Christine
authors.initials: C
authors.lastname: Schneider
authors.affiliation: From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.).
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.affiliation: From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.).
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.affiliation: From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.).
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.affiliation: From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.).
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.affiliation: From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.). christian.nolte@charite.de.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016037:Single-Blind Method; D020521:Stroke / Q000097:blood* / Q000000981:diagnostic imaging*; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: acute coronary syndrome; coronary angiography; nervous system; stroke; troponin