Hypertension and atrial fibrillation: prognostic aspects of troponin elevations in clinical practice

• Published in: Critical pathways in cardiology Vol. 13; no. 4; p. 141
• Main Authors: Conti, Alberto, Alesi, Andrea, Trausi, Federica, Scorpiniti, Margherita, Angeli, Elena, Bigiarini, Sofia, Bianchi, Simone, Donnini, Chiara, Lazzeretti, Delia, Padeletti, Luigi
• Format: Journal Article
• Language: English
• Published: United States 01-12-2014
• Subjects: Adult; Aged; Aged, 80 and over; Atrial Fibrillation - blood; Coronary Artery Disease - blood; Coronary Artery Disease - therapy; Echocardiography; Exercise Test; Female; Follow-Up Studies; Gastrointestinal Diseases - diagnosis; Humans; Hypertension - blood; Length of Stay; Male; Middle Aged; Prognosis; Risk Factors; Troponin I - blood
• ISSN: 1535-2811
• DOI: 10.1097/HPC.0000000000000028

Hypertension and atrial fibrillation (AFib) frequently coexist in clinical practice. However, it is unclear whether this association per se or in combination with coronary artery disease (CAD) is a predictor of adverse outcomes.
The aim of this study is to recognize and treat CAD in patients with hypertension and AFib.
Patients with long-standing hypertension and recent-onset AFib (lasting ≤48 hours) were enrolled and managed with standard care regardless of the presence of troponin elevations (e-TnI) (group 1, n=636, 2010-2011 years) or managed with tailored-care including echocardiography and stress testing when presenting with e-TnI (group 2, n=663, 2012-2013 years).
The composite of ischemic vascular events including stroke, acute coronary syndrome, revascularization, and death at the 6-month follow-up.
Out of 1299 patients enrolled, those with e-TnI (56 and 57 in groups 2 and 1, respectively, P=0.768) were more likely to admit in group 2 vs. group 1 (21 vs. 32, respectively, P=0.060), and less likely to undergo stress testing in group 2 vs. group 1 (15 vs. 1, respectively, P<0.001). Twenty-one patients in group 2 were admitted with positive stress testing (n=9) or high e-TnI (n=12; 1.04±1.98 ng/mL); conversely 35 were discharged with negative stress testing (n=6) or very-low e-TnI (n=29; 0.27±0.22 ng/mL). Finally, 7 patients vs. 1, in groups 2 and 1, respectively, underwent revascularization (P=0.032), and 3 vs. 12 reached the endpoint (P=0.024). On multivariate analysis, e-TnI, known CAD and age were predictors of the endpoint.
In patients with hypertension, AFib, and e-TnI, tailored-care inclusive of echocardiography and stress testing succeeded in recognizing and treating CAD avoiding adverse events without increase in admissions.