Background Recent evidence suggests cardiac troponin levels to be a marker of increased vascular risk. We aimed to assess whether levels of high‐sensitivity cardiac troponin T (hs‐cTnT) are associated with recurrent vascular events and death in patients with first‐ever, mild to moderate ischemic stroke. Methods and Results We used data from the PROSCIS‐B (Prospective Cohort With Incident Stroke Berlin) study. We computed Cox proportional hazards regression analyses to assess the association between hs‐cTnT levels upon study entry (Roche Elecsys, upper reference limit, 14 ng/L) and the primary outcome (composite of recurrent stroke, myocardial infarction, and all‐cause death). A total of 562 patients were analyzed (mean age, 67 years [SD 13]; 38.6% women; median National Institutes of Health Stroke Scale=2; hs‐cTnT above upper reference limit, 39.2%). During a mean follow‐up of 3 years, the primary outcome occurred in 89 patients (15.8%), including 40 (7.1%) recurrent strokes, 4 (0.7%) myocardial infarctions, and 51 (9.1%) events of all‐cause death. The primary outcome occurred more often in patients with hs‐cTnT above the upper reference limit (27.3% versus 10.2%; adjusted hazard ratio, 2.0; 95% CI, 1.3–3.3), with a dose‐response relationship when the highest and lowest hs‐cTnT quartiles were compared (15.2 versus 1.8 events per 100 person‐years; adjusted hazard ratio, 4.8; 95% CI, 1.9–11.8). This association remained consistent in sensitivity analyses, which included age matching and stratification for sex. Conclusions Hs‐cTnT is dose‐dependently associated with an increased risk of recurrent vascular events and death within 3 years after first‐ever, mild to moderate ischemic stroke. These findings support further studies of the utility of hs‐cTnT for individualized risk stratification after stroke.

Public education campaigns are recommended to increase awareness for stroke. The effect of a public advertising and education campaign in an urban region in Germany was assessed and compared with a control region. We hypothesized that such a campaign would increase the number of patients being admitted by emergency medical services (EMS). A multimedia campaign and targeted education of health care professionals and the public was employed in Berlin during six consecutive months to disseminate knowledge about stroke symptoms and appropriate actions to take. Data on time to hospital admission and details on transport were retrieved from registries for the episode before, during, and after the campaign. To test the effect of the campaign, it was compared with another urban region in Germany (Ruhr-Area), where no campaign had been conducted. Between January 2010 and February 2011, 9,166 patients with stroke or transient ischemic attack (TIA) were documented in Berlin and 9,994 in the Ruhr-Area. In both regions, following the campaign period, patients were more often admitted to hospital within the first 2 hr after onset (Berlin: odds ratio [OR] = 1.16, 95% confidence interval [CI] = [1.02, 1.32]; Ruhr-Area: OR = 1.18, 95% CI = [1.05, 1.34]). Patients were more likely being admitted via EMS after the campaign (Berlin: OR = 1.71, 95% CI = [1.50, 1.94]; Ruhr-Area: OR = 1.34, 95% CI = [1.17, 1.53]). The results suggest that an increased uptake of EMS triggered shorter time to hospital admission. A reduction in delay to hospitalization and an increased uptake of EMS were observed over the study period for both regions. No effect of the campaign was identified.