TY - JOUR
T1 - Long-term prognostic value of dysglycemia and ischemic vascular disease beyond abnormal troponin levels in patients presenting acute atrial fibrillation
AU - Conti, Alberto
AU - Mariannini, Yuri
AU - Poggioni, Claudio
AU - Viviani, Gabriele
AU - Luzzi, Margherita
AU - De Bernardis, Niccolò
AU - Padeletti, Luigi
AU - Gensini, Gian Franco
PY - 2013/3
Y1 - 2013/3
N2 - Background: Prognostication beyond troponin levels in patients with acute atrial fibrillation (AF) is still unclear. Methods: One-month and 1-year outcomes in 1091 patients with acute AF were analyzed. Primary endpoints were stroke or the composite of acute coronary syndrome, revascularization, and death. Results: In the short term, troponin (odds ratio (OR) 15, 95% confidence interval (CI), 3.4-67.9, P <0.001) and known ischemic heart disease (OR 5.83, 95% CI, 1.3-26.2, P = 0.021) were predictors of the composite endpoint, with multivariate analysis. No variables linked with stroke. In the long term, metabolic syndrome (OR 4.7, 95% CI, 1.2-18.3, P = 0.024) and age (OR 1.1, 95% CI, 1.0-1.1, P = 0.009) were predictors of stroke; metabolic syndrome (OR 4.3, 95% CI, 1.6-11.0, P = 0.003), known ischemic heart disease (OR 3.3, 95% CI, 1.7-6.4, P = 0.001), persistence of AF after the first-line approach (OR 2.2, 95% CI, 1.2-4.3, P = 0.018), and age (OR 1.0, 95% CI, 1.0-1.1, P = 0.025), but not troponin so were of the composite endpoint. In the short term, increased discriminative values in prognostication of the composite endpoint were observed with C-statistic when troponin was compared with dysglycemia (P = 0.032). No variables did better than others in the prognostication of stroke. In the long term, increased discriminative values in the prognostication of stroke were observed with C-statistic when age was compared with troponin (P = 0.020), ischemic heart disease (P = 0.025), and persistence of AF after the first-line approach (P = 0.049); so was for CHADS2 score ≥1 versus vascular disease (P = 0.038). Conclusions: In patients with acute AF, abnormal troponin levels add prognostic value to clinical parameters in the short term; dysglycemia and known vascular disease in the long term.
AB - Background: Prognostication beyond troponin levels in patients with acute atrial fibrillation (AF) is still unclear. Methods: One-month and 1-year outcomes in 1091 patients with acute AF were analyzed. Primary endpoints were stroke or the composite of acute coronary syndrome, revascularization, and death. Results: In the short term, troponin (odds ratio (OR) 15, 95% confidence interval (CI), 3.4-67.9, P <0.001) and known ischemic heart disease (OR 5.83, 95% CI, 1.3-26.2, P = 0.021) were predictors of the composite endpoint, with multivariate analysis. No variables linked with stroke. In the long term, metabolic syndrome (OR 4.7, 95% CI, 1.2-18.3, P = 0.024) and age (OR 1.1, 95% CI, 1.0-1.1, P = 0.009) were predictors of stroke; metabolic syndrome (OR 4.3, 95% CI, 1.6-11.0, P = 0.003), known ischemic heart disease (OR 3.3, 95% CI, 1.7-6.4, P = 0.001), persistence of AF after the first-line approach (OR 2.2, 95% CI, 1.2-4.3, P = 0.018), and age (OR 1.0, 95% CI, 1.0-1.1, P = 0.025), but not troponin so were of the composite endpoint. In the short term, increased discriminative values in prognostication of the composite endpoint were observed with C-statistic when troponin was compared with dysglycemia (P = 0.032). No variables did better than others in the prognostication of stroke. In the long term, increased discriminative values in the prognostication of stroke were observed with C-statistic when age was compared with troponin (P = 0.020), ischemic heart disease (P = 0.025), and persistence of AF after the first-line approach (P = 0.049); so was for CHADS2 score ≥1 versus vascular disease (P = 0.038). Conclusions: In patients with acute AF, abnormal troponin levels add prognostic value to clinical parameters in the short term; dysglycemia and known vascular disease in the long term.
KW - atrial fibrillation
KW - diabetes mellitus
KW - dysglycemia
KW - emergency medicine
KW - ischemic heart disease
KW - metabolic syndrome
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=84874360305&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84874360305&partnerID=8YFLogxK
U2 - 10.1097/HPC.0b013e31827f120b
DO - 10.1097/HPC.0b013e31827f120b
M3 - Article
C2 - 23411603
AN - SCOPUS:84874360305
VL - 12
SP - 14
EP - 23
JO - Critical Pathways in Cardiology
JF - Critical Pathways in Cardiology
SN - 1535-282X
IS - 1
ER -