Relative Lack of Culprit and Obstructive Coronary Lesions in Patients With Acute Ischemic Stroke and Elevated Cardiac Troponin

The measurement of cardiac troponins (cTn) is widely used to diagnose myocardial injury or necrosis 1, 2 , and has become an important tool for the risk stratification and clinical management of patients with acute coronary syndrome (ACS) 3, 4 . However, elevated cTn levels are also found in non-ACS patients 5 . For example, in a recent study of patients with chronic stable coronary artery disease, higher cTn levels were observed in patients with concomitant kidney disease or diabetes mellitus 6, 7 . Furthermore, approximately 15% of patients with acute ischemic stroke have elevated cTn 8-11 ; many of whom, have no other clinical manifestation of acute coronary ischemia. Because cTn still provides important prognostic information regarding mortality outcomes in stroke patients 12 , current AHA guidelines recommend its measurement in all patients presenting with acute ischemic stroke 13 . However, the role of cTn in predicting culprit or obstructive coronary lesions in these patients remains unknown, but may be important to ascertain if subsequent revascularization therapy could be shown to be beneficial.