Underutilization of Cardiac Therapies in Patients with Acute Ischemic Stroke and Elevated Troponin.

Abstract

INTRODUCTION Recent findings have shown that in acute ischemic stroke (AIS) patients, elevated troponin is associated with increased mortality. However, due to concerns of cerebral hypoperfusion and hemorrhagic transformation, current practice has been slow to apply proven cardiac therapies to these patients. This study aims to determine this rate of utilization. MATERIALS/METHODS A single-center review of 83 patients with AIS and measured troponin was conducted. Patients were stratified based on elevated and non-elevated troponin. Between groups, we measured the utilization of evidence-based cardiac therapies and used a univariate logistic regression to compare outcomes of mortality, re-hospitalization, recurrent acute ischemic stroke, recurrent acute myocardial infarction, and a composite of these outcomes. RESULTS Of 83 patients, 25 had elevated troponin and 58 had non-elevated troponin. There was no statistical difference in the use of cardiac therapies between the two groups. P2Y12 antagonists were infrequently used in both elevated and non- elevated troponin groups at 32% vs. 24% (p=0.64), as were ACE/ARBs at 56% vs. 69% (p=0.38). Those in the elevated troponin group encountered a statistically significant increase in composite endpoint 64% vs. 33% (OR 7.28, 95% CI 2.19-28.88, p<0.01). CONCLUSIONS Cardiac therapies are underutilized in patients with acute ischemic stroke and elevated troponin levels. In turn, this low usage may explain the increase in morbidity and mortality seen in these patients and the use of such therapies should be considered when treating this subset of patients as the cardioprotective nature of these therapies may outweigh the risks associated with them in AIS patients.