Abstract 19723: Troponin Elevations in Ischemic Stroke are Associated With Stroke Severity and Advanced Age

Introduction: Troponin elevations are common in patients with hemorrhagic stroke where they have been attributed to sympathomimetic states and stroke severity. Troponin elevations are less common in patients with ischemic stroke and have been associated with insular cortex location but there are no studies evaluating the impact of stroke severity. The diagnosis of type II MI/ myocardial strain is a co-morbidity that increases case-mix index and impacts DRG assignment. Hypothesis: Troponin elevations in ischemic stroke is related to stroke severity and older age, independent of severity. Methods: All patients with ischemic stroke at University Hospitals Case Medical Center from January 2014 to April 2015 were retrospectively reviewed. Data was collected on demographics, stroke severity by National Institutes of Health Stroke Score (NIHSS), and serial troponin values. Results: Of 629 patients with ischemic stroke, 478 met inclusion criteria including initial and follow up troponin levels. Elevated troponin levels were found in 28.2% of patients- 16.3% in high and 11.9% in critical ranges. Troponin elevations were associated with stroke severity. Although initial troponin values were not significantly different for the more severe ischemic strokes (NIHSS ≥ 10) vs less severe (NIHSS <10) for the initial troponin value, they were significantly higher on follow up values (p<0.001). This was more apparent when stratified by age; initial and peak troponin values increased in both age groups, more for those ≥65 (p=0.0003), but was observed for younger patients as well (<65, p=0.03). Conclusions: Elevated troponin levels occur in 28.2% of patients with ischemic stroke, 11.9% in the critical range, and are associated with higher stroke severity and advanced age. Patients with more severe stroke and advanced age are more likely to have troponin elevations on follow up testing thus a baseline value alone may not be sufficient to assess risk or establish the cardiac diagnosis.