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

Alberto Conti, Andrea Alesi, Federica Trausi, Margherita Scorpiniti, Elena Angeli, Sofia Bigiarini, Simone Bianchi, Chiara Donnini, Delia Lazzeretti, Luigi Padeletti

Research output: Contribution to journalArticle

Abstract

Background: 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. Aim: The aim of this study is to recognize and treat CAD in patients with hypertension and AFib. Methods: 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). Endpoint: The composite of ischemic vascular events including stroke, acute coronary syndrome, revascularization, and death at the 6-month follow-up. Results: 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. Conclusions: 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.

Original languageEnglish
Pages (from-to)141-146
Number of pages6
JournalCritical Pathways in Cardiology
Volume13
Issue number4
DOIs
Publication statusPublished - 2014

Keywords

  • Atrial fibrillation
  • Cardiac biomarkers
  • Coronary artery disease
  • Emergency medicine
  • Hypertension
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Conti, A., Alesi, A., Trausi, F., Scorpiniti, M., Angeli, E., Bigiarini, S., Bianchi, S., Donnini, C., Lazzeretti, D., & Padeletti, L. (2014). Hypertension and atrial fibrillation: Prognostic aspects of troponin elevations in clinical practice. Critical Pathways in Cardiology, 13(4), 141-146. https://doi.org/10.1097/HPC.0000000000000028