Long-term prognostic value of dysglycemia and ischemic vascular disease beyond abnormal troponin levels in patients presenting acute atrial fibrillation

Alberto Conti, Yuri Mariannini, Claudio Poggioni, Gabriele Viviani, Margherita Luzzi, Niccolò De Bernardis, Luigi Padeletti, Gian Franco Gensini

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)14-23
Number of pages10
JournalCritical Pathways in Cardiology
Volume12
Issue number1
DOIs
Publication statusPublished - Mar 2013

Keywords

  • atrial fibrillation
  • diabetes mellitus
  • dysglycemia
  • emergency medicine
  • ischemic heart disease
  • metabolic syndrome
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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