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Introduction: Stroke is the fifth leading cause of death in the US and a major cause of disability. Atrial fibrillation (AF) increases the risk of ischemic stroke fivefold. Cardioembolic stroke in patients with AF is associated with high mortality. The association of elevated cardiac troponin with mortality in patients with acute ischemic stroke has been studied previously; however, there is limited data in subgroups of ischemic stroke etiology. We sought to determine the association of troponin elevation at presentation with 90-day all-cause mortality in patients with acute ischemic stroke and AF. Methods: The I nitiation of A nticoagulation after C ardioembolic Stroke (IAC) study is a multicenter cohort drawn from eight US Stroke Centers. We included consecutive patients hospitalized with acute ischemic stroke and AF between 2015-2018, who had an initial baseline cardiac troponin I (bcTnI) obtained at presentation. The primary outcome was all-cause mortality at 90 days from stroke onset. We undertook multivariable logistic regression to determine the association between elevated bcTnl (≥0.1 ng/mL) and 90-day mortality. Results: Of the 2084 patients enrolled in IAC, 1889 patients had 90-day follow-up of which 1461 patients had bcTnI available. 239 of the included patients (16.4%) had an elevated bcTnl, and death within 90-days occurred in 323 patients (22.1%). Elevated bcTnI was associated with 90-day mortality in univariable analysis (49.4% vs 24.9%; OR 1.71, 95% CI 1.17-2.50, p Conclusion: In acute ischemic stroke patients with AF, elevated bcTnI was independently associated with 90-day all-cause mortality.

Introduction: Neurologic deterioration (ND) occurs in a quarter of acute lacunar infarcts and may lead to severe disability, but underlying pathophysiology of ND remains poorly understood. We sought to identify risk factors and clinical characteristics associated with ND. Methods: This retrospective observational study included consecutive patients with acute lacunar stroke admitted to New York University Langone Health and Brown University (NYU/Brown). Lacunar stroke was defined as a subcortical infarct 50%) in the parent vessel and no cardioembolic source. We defined ND as any neurologic deterioration referable to the lacunar stroke and not related to a medical or non-cerebrovascular neurological complication. We used logistic regression analyses to determine associations between ND and luminal stenosis ( Results: The NYU/Brown sample included 205 patients, of whom 41 (20%) had ND. In adjusted models, we found no definite association between luminal stenosis and ND (aOR 1.74, 95% CI 0.73-4.14). From CU, 361 total patients were included, of whom 59 (16%) had ND. In adjusted models, we found an association between luminal stenosis and ND (aOR 2.28 95% CI 1.15-4.50). Meta-analysis of both cohorts found luminal stenosis associated with ND (RR [95% CI]: 1.75 [1.23-2.49]). Conclusions: In this multi-center study, luminal stenosis (