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 and 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. Adenosine diphosphate
P2Y12 antagonists were infrequently used in both elevated and non-elevated troponin groups at 32%
vs. 24% (p = 0.64), as were Angiotensin-Converting Enzyme Inhibitors (ACE-I) and angiotensin II
receptor blockers (ARB) at 56% vs. 69% (p = 0.38). Those in the elevated troponin group encountered
a statistically significant increase in composite endpoint 64% vs. 33% (Odds Ratio [OR] 7.28,
95% Confidence interval [CI] 2.19-28.88, p<0.01).
Conclusion: 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 cardio protective nature of these therapies may outweigh the risks associated with them in AIS