Abstract

BackgroundCurrent guidelines recommend measurement of troponin in acute ischemic stroke (AIS) patients. In AIS patients, troponin elevation is associated with increased mortality and worse outcome. However, uncertainty remains regarding the underlying pathophysiology of troponin elevation after stroke, particularly regarding diagnostic and therapeutic consequences. Troponin elevation may be caused by coronary artery disease (CAD) and more precisely acute coronary syndrome (ACS). Both have a high prevalence in stroke patients and contribute to poor outcome. Therefore, better diagnostic algorithms are needed to identify those AIS patients likely to have ACS or other manifestations of CAD.Methods/designThe primary goal of the “PRediction of Acute coronary syndrome in acute Ischemic StrokE” (PRAISE) study is to develop a diagnostic algorithm for prediction of ACS in AIS patients. The primary hypothesis will test whether dynamic high-sensitivity troponin levels determined by repeat measurements (i.e., “rise or fall-pattern”) indicate presence of ACS when compared to stable (chronic) troponin elevation.PRAISE is a prospective, multicenter, observational trial with central reading and predefined endpoints guided by a steering committee. Clinical symptoms, troponin levels as well as findings on electrocardiogram, echocardiogram, and coronary angiogram will be recorded and assessed by central academic core laboratories. Diagnosis of ACS will be made by an endpoint adjudication committee. Severe adverse events will be evaluated by a critical event committee. Safety will be judged by a data and safety monitoring board. Follow-up will be conducted at three and twelve months and will record new vascular events (i.e., stroke and myocardial infarction) as well as death, functional and cognitive status.According to sample size calculation, 251 patients have to be included.DiscussionPRAISE will prospectively determine the frequency of ACS and characterize cardiac and coronary pathologies in a large, multicenter cohort of AIS patients with troponin elevation. The findings will elucidate the origin of troponin elevation, shed light on its impact on necessary diagnostic procedures and provide data on the safety and diagnostic yield of coronary angiography early after stroke. Thereby, PRAISE will help to refine algorithms and develop guidelines for the cardiac workup in AIS.Trial registrationNCT03609385 registered 1st August 2018.

Highlights

  • Current guidelines recommend measurement of troponin in acute ischemic stroke (AIS) patients

  • PRAISE will prospectively determine the frequency of acute coronary syndrome (ACS) and characterize cardiac and coronary pathologies in a large, multicenter cohort of AIS patients with troponin elevation

  • Since cardiac troponin (cTn) is a specific biomarker of cardiomyocyte injury, it is obvious to assume that cardiac diseases attribute to worse clinical outcome in stroke patients

Read more

Summary

Introduction

Current guidelines recommend measurement of troponin in acute ischemic stroke (AIS) patients. Troponin elevation may be caused by coronary artery disease (CAD) and more precisely acute coronary syndrome (ACS). Both have a high prevalence in stroke patients and contribute to poor outcome. Current guidelines by the American Heart Association/American Stroke Association (AHA/ASA) recommend troponin assessment in stroke patients [5]. This recommendation emphasizes that assessment of cardiovascular status is important in AIS patients. It refers to the robust observation, that elevation of cardiac troponin (cTn) indicates a higher risk for both mortality and poor outcome [6, 7]. Since cTn is a specific biomarker of cardiomyocyte injury, it is obvious to assume that cardiac diseases attribute to worse clinical outcome in stroke patients

Methods
Findings
Discussion
Conclusion

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.