Abstract
Background Patients with recent-onset atrial fibrillation (AF) and cardiac troponin I (cTnI) elevations show poor outcomes. Coronary heart disease might be a cause, consequence, or an innocent bystander. Objective The aim of this study was to recognize and treat coronary heart disease to avoid adverse events. Methods Patients with recent-onset AF participated in the study. The exclusion criteria were acute coronary syndrome and severe comorbidities. Patients managed with standard care (group 1, n=1086, years 2010-2011) were compared with patients managed with tailored care inclusive of echocardiography and stress testing when required (group 2, n=1055, years 2012-2013). Endpoint The endpoint was a composite of ischemic vascular events including stroke, acute coronary syndrome, revascularization and cardiovascular death at 6 months of follow-up. Results Of 4008 patients considered, 2141 were enrolled; 183 showed cTnI elevations, 92 in group 1 and 91 in group 2. cTnI elevations, known ischemic heart disease and age were predictors of the endpoint on multivariate analysis. Overall, two versus seven patients (P=0.033) in groups 1 and 2, respectively, underwent revascularization. Eventually, 16 patients in group 1 versus five patients in group 2 reached the endpoint (P=0.019). Patients of group 2 were managed as follow: 35 were admitted, 15 with positive stress testing and 20 with high cTnI values (mean values: 0.64±1.01 ng/ml). Fifty-six patients were discharged with negative stress testing results (n=13) or very low cTnI values (n=43, mean values 0.29±0.30 ng/ml). Conclusion In patients with AF and cTnI elevations, tailored care inclusive of echocardiography and stress testing succeeded in recognizing and treating masked 'critical' coronary heart disease, avoiding adverse events.
| Original language | English |
|---|---|
| Pages (from-to) | 162-169 |
| Number of pages | 8 |
| Journal | European Journal of Emergency Medicine |
| Volume | 22 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Dec 1 2015 |
Fingerprint
Keywords
- atrial fibrillation
- cardiac biomarkers
- coronary artery disease
- emergency medicine
- prognosis
- risk assessment
ASJC Scopus subject areas
- Emergency Medicine
Cite this
Role of masked coronary heart disease in patients with recent-onset atrial fibrillation and troponin elevations. / Conti, Alberto; Mariannini, Yuri; Canuti, Erica; Cerini, Gabriele; De Bernardis, Niccolò; Gigli, Chiara; Giampieri, Margherita; Viviani, Gabriele; Poggioni, Claudio; Padeletti, Luigi.
In: European Journal of Emergency Medicine, Vol. 22, No. 3, 01.12.2015, p. 162-169.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Role of masked coronary heart disease in patients with recent-onset atrial fibrillation and troponin elevations
AU - Conti, Alberto
AU - Mariannini, Yuri
AU - Canuti, Erica
AU - Cerini, Gabriele
AU - De Bernardis, Niccolò
AU - Gigli, Chiara
AU - Giampieri, Margherita
AU - Viviani, Gabriele
AU - Poggioni, Claudio
AU - Padeletti, Luigi
PY - 2015/12/1
Y1 - 2015/12/1
N2 - Background Patients with recent-onset atrial fibrillation (AF) and cardiac troponin I (cTnI) elevations show poor outcomes. Coronary heart disease might be a cause, consequence, or an innocent bystander. Objective The aim of this study was to recognize and treat coronary heart disease to avoid adverse events. Methods Patients with recent-onset AF participated in the study. The exclusion criteria were acute coronary syndrome and severe comorbidities. Patients managed with standard care (group 1, n=1086, years 2010-2011) were compared with patients managed with tailored care inclusive of echocardiography and stress testing when required (group 2, n=1055, years 2012-2013). Endpoint The endpoint was a composite of ischemic vascular events including stroke, acute coronary syndrome, revascularization and cardiovascular death at 6 months of follow-up. Results Of 4008 patients considered, 2141 were enrolled; 183 showed cTnI elevations, 92 in group 1 and 91 in group 2. cTnI elevations, known ischemic heart disease and age were predictors of the endpoint on multivariate analysis. Overall, two versus seven patients (P=0.033) in groups 1 and 2, respectively, underwent revascularization. Eventually, 16 patients in group 1 versus five patients in group 2 reached the endpoint (P=0.019). Patients of group 2 were managed as follow: 35 were admitted, 15 with positive stress testing and 20 with high cTnI values (mean values: 0.64±1.01 ng/ml). Fifty-six patients were discharged with negative stress testing results (n=13) or very low cTnI values (n=43, mean values 0.29±0.30 ng/ml). Conclusion In patients with AF and cTnI elevations, tailored care inclusive of echocardiography and stress testing succeeded in recognizing and treating masked 'critical' coronary heart disease, avoiding adverse events.
AB - Background Patients with recent-onset atrial fibrillation (AF) and cardiac troponin I (cTnI) elevations show poor outcomes. Coronary heart disease might be a cause, consequence, or an innocent bystander. Objective The aim of this study was to recognize and treat coronary heart disease to avoid adverse events. Methods Patients with recent-onset AF participated in the study. The exclusion criteria were acute coronary syndrome and severe comorbidities. Patients managed with standard care (group 1, n=1086, years 2010-2011) were compared with patients managed with tailored care inclusive of echocardiography and stress testing when required (group 2, n=1055, years 2012-2013). Endpoint The endpoint was a composite of ischemic vascular events including stroke, acute coronary syndrome, revascularization and cardiovascular death at 6 months of follow-up. Results Of 4008 patients considered, 2141 were enrolled; 183 showed cTnI elevations, 92 in group 1 and 91 in group 2. cTnI elevations, known ischemic heart disease and age were predictors of the endpoint on multivariate analysis. Overall, two versus seven patients (P=0.033) in groups 1 and 2, respectively, underwent revascularization. Eventually, 16 patients in group 1 versus five patients in group 2 reached the endpoint (P=0.019). Patients of group 2 were managed as follow: 35 were admitted, 15 with positive stress testing and 20 with high cTnI values (mean values: 0.64±1.01 ng/ml). Fifty-six patients were discharged with negative stress testing results (n=13) or very low cTnI values (n=43, mean values 0.29±0.30 ng/ml). Conclusion In patients with AF and cTnI elevations, tailored care inclusive of echocardiography and stress testing succeeded in recognizing and treating masked 'critical' coronary heart disease, avoiding adverse events.
KW - atrial fibrillation
KW - cardiac biomarkers
KW - coronary artery disease
KW - emergency medicine
KW - prognosis
KW - risk assessment
UR - http://www.scopus.com/inward/record.url?scp=84942294936&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84942294936&partnerID=8YFLogxK
U2 - 10.1097/MEJ.0000000000000130
DO - 10.1097/MEJ.0000000000000130
M3 - Article
C2 - 24557149
AN - SCOPUS:84942294936
VL - 22
SP - 162
EP - 169
JO - European Journal of Emergency Medicine
JF - European Journal of Emergency Medicine
SN - 0969-9546
IS - 3
ER -