The aim of the current study was to describe troponin levels in patients with large vessel occlusion (LVO) who underwent mechanical thrombectomy (MT) and associated outcomes.

Elevated troponin levels during acute ischemic stroke have been associated with atrial fibrillation, increased National Institutes of Health Stroke Scale (NIHSS) score, embolic stroke, and cardioembolic stroke.

Data was retrospectively abstracted from a tertiary-care, comprehensive stroke center database of patients with LVO undergoing MT between February 2015 and September 2018. We compared baseline characteristics and overall outcomes of patients with normal (<0.034), mildly elevated (0.034-0.2), and critically elevated (>0.2) admission and peak troponin levels.  Multivariate logistic regression model was used to adjust for socio-demographics, admission NIHSS, and successful reperfusion defined as thrombolysis-in-cerebral-infarction 2b-3. 

Of the 348 consecutive patients identified, troponin levels were obtained in 204 (59%) patients. The mean age was 71+14 years, 47% were female, and 43% were Hispanic. The mean admission NIHSS was 16±9.0 and 53% had cardioembolic stroke. Median admission troponin was 0 (IQR 0-0.04; range 0-27.4) and peak troponin was 0.08 (IQR 0-0.66; range 0-49.4). Admission and peak troponin was >0.2 in 26/204 (13%) and 40/204 (19%) patients respectively. 21/348 (6%) were diagnosed with myocardial infarction (MI). Normal admission troponin was less likely to be associated with symptomatic hemorrhagic conversion (sICH) (OR 0.35, p 0.049). Peak troponin >0.2 was associated with higher inpatient mortality (OR 11.2, p 0.035); however, this association was not significant after excluding patients with MI (p 0.51). There was no difference in good functional outcome on discharge (modified Rankin Score 0-3).

Patients with normal troponin in the setting of LVO had lower risk of sICH after MT. Elevated peak troponin >0.2 is independently associated with in-hospital mortality; however, this association is driven primarily by patients with confirmed MI.