title: Routine Troponin Measurements Are Unnecessary to Exclude Asymptomatic Coronary Events in Acute Ischemic Stroke Patients.
abstract: BACKGROUND
  Obtaining serum troponin levels in every patient with acute stroke is recommended in recent stroke guidelines, but there is no evidence that these contribute positively to clinical care. We sought to determine the clinical significance of measuring troponin levels in acute ischemic stroke patients.
  
  
  METHODS
  We reviewed 398 consecutive patients with acute ischemic stroke at a large academic institution from 2010 to 2012. Troponin levels were measured as a result of protocol in place during part of the study period. The mean age was 70 years (standard deviation ±16 years) and 197 (49.5%) were men.
  
  
  RESULTS
  Chronic kidney disease was present in 78 (19.6%), coronary artery disease in 107 (26.9%), and atrial fibrillation in 107 (26.9%). Serum troponin T was measured in 246 of 398 patients (61.8%). Troponin was elevated (>.01 ng/mL) at any point in 38 of 246 patients (15.5%) and was elevated in 28 patients at all 3 measurements (11.3% of those with troponin measured). Only 4 of 246 patients (1.6%) had a significant uptrend. Two were iatrogenic in the setting of hemodynamic augmentation using vasopressors to maintain cerebral perfusion. One case was attributed to stroke and chronic kidney disease and another case to heart failure from inflammatory fibrocalcific mitral valvular heart disease.
  
  
  CONCLUSIONS
  Serum troponin elevation in patients with ischemic stroke is not usually caused by clinically significant acute myocardial ischemia unless iatrogenic in the setting of vasopressor administration. Serum troponin levels should be measured judicially, based on clinical context, rather than routinely in all stroke patients.
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Farwa
authors.initials: F
authors.lastname: Ali
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Young
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Flemming
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota. Electronic address: Fugate.jennifer@mayo.edu.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Fugate
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D020107:Troponin T / Q000097:blood*; D019564:Unnecessary Procedures; D015854:Up-Regulation; D014662:Vasoconstrictor Agents / Q000009:adverse effects
chemical_list: D015415:Biomarkers; D020107:Troponin T; D014662:Vasoconstrictor Agents
keywords: Acute stroke; coronary events; ischemic stroke; troponin