Coronary atherosclerosis and adverse outcomes in patients with recent-onset atrial fibrillation and troponin rise

• Published in: The American journal of emergency medicine Vol. 33; no. 10; pp. 1407 - 1413
• Main Authors: Conti, Alberto, MD, Angeli, Elena, MD, Scorpiniti, Margherita, MD, Alesi, Andrea, MD, Trausi, Federica, MD, Lazzeretti, Delia, MD, Padeletti, Luigi, MD, Gensini, Gian Franco, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2015; Elsevier Limited
• Subjects: Acute coronary syndromes; Aged; Anticoagulants; Atherosclerosis; Atrial Fibrillation - blood; Biomarkers - blood; Cardiac arrhythmia; Cardiomyopathy; Cardiovascular disease; Coronary Angiography; Coronary Artery Disease - diagnosis; Coronary Artery Disease - therapy; Coronary vessels; Diabetes; Electrocardiography; Emergency; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Female; Follow-Up Studies; Heart attacks; Heart failure; Humans; Hypertension; Italy; Kidney diseases; Laboratories; Male; Medical imaging; Mortality; Multivariate analysis; Myocardial Revascularization; Prognosis; Propensity Score; Troponin - blood; Italy
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2015.07.013

Abstract Background The relationship between troponin and atrial fibrillation (AF) without acute coronary syndrome is still unclear. We sought to investigate the presence of coronary atherosclerosis and adverse outcomes in patients with AF. Methods Consecutive patients with recent-onset AF and without severe comorbidities were enrolled between 2004 and 2013. Patients with a troponin rise or with adverse outcomes were considered for coronary angiography and revascularization when “critical” stenosis (≥ 70%) was recognized. Propensity score matching was performed to adjust for baseline characteristics; after matching, no differences existed between the groups of patients with or without troponin rise. The primary end point was the composite of acute coronary syndrome, revascularization, and cardiac death at 1- and 12-month follow-ups. Results Of 3627 patients enrolled, 3541 completed the study; 202 (6%) showed troponin rise; and 91 (3%), an adverse outcome. In the entire cohort, on multivariate analysis, the odds ratio for the occurrence of the primary end point of troponin rise was 14 (95% confidence interval [CI], 10-23; P < .001), and that of known coronary artery disease was 3 (CI, 2-5; P = .001). In the matching cohort, the odds ratio of troponin rise was 10 (CI, 4-22; P < .001), and that of TIMI score greater than 2 was 4 (CI, 2-9; P ≤ .001). In the entire cohort, patients with or without troponin rise achieved the primary end point in 38 (19%) and 43 (1%) patients, respectively ( P < .001). Stroke occurred in 4 (2%) and 20 (1%), respectively ( P = .018). Critical stenosis and revascularization account for 23 (12%) and 15 (1%), respectively ( P < .001). In the matching cohort, results were confirmed, but incidence of stroke was comparable. Conclusions Patients with recent-onset AF and troponin rise showed higher prevalence of coronary atherosclerosis and adverse cardiac events. Stroke per se did not succeed in justifying the high morbidity. Thus, beyond stroke, coronary atherosclerosis might have a pivotal role in poor outcomes.