Role of masked coronary heart disease in patients with recent-onset atrial fibrillation and troponin elevations

Alberto Conti, Yuri Mariannini, Erica Canuti, Gabriele Cerini, Niccolò De Bernardis, Chiara Gigli, Margherita Giampieri, Gabriele Viviani, Claudio Poggioni, Luigi Padeletti

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)162-169
Number of pages8
JournalEuropean Journal of Emergency Medicine
Volume22
Issue number3
DOIs
Publication statusPublished - Dec 1 2015

Fingerprint

Troponin
Atrial Fibrillation
Coronary Disease
Troponin I
Stress Echocardiography
Acute Coronary Syndrome
Myocardial Ischemia
Blood Vessels
Comorbidity
Multivariate Analysis
Stroke

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 journalArticle

Conti, A, Mariannini, Y, Canuti, E, Cerini, G, De Bernardis, N, Gigli, C, Giampieri, M, Viviani, G, Poggioni, C & Padeletti, L 2015, 'Role of masked coronary heart disease in patients with recent-onset atrial fibrillation and troponin elevations', European Journal of Emergency Medicine, vol. 22, no. 3, pp. 162-169. https://doi.org/10.1097/MEJ.0000000000000130
Conti, Alberto ; Mariannini, Yuri ; Canuti, Erica ; Cerini, Gabriele ; De Bernardis, Niccolò ; Gigli, Chiara ; Giampieri, Margherita ; Viviani, Gabriele ; Poggioni, Claudio ; Padeletti, Luigi. / Role of masked coronary heart disease in patients with recent-onset atrial fibrillation and troponin elevations. In: European Journal of Emergency Medicine. 2015 ; Vol. 22, No. 3. pp. 162-169.
@article{f391c55541424b978b7680c604633555,
title = "Role of masked coronary heart disease in patients with recent-onset atrial fibrillation and troponin elevations",
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.",
keywords = "atrial fibrillation, cardiac biomarkers, coronary artery disease, emergency medicine, prognosis, risk assessment",
author = "Alberto Conti and Yuri Mariannini and Erica Canuti and Gabriele Cerini and {De Bernardis}, Niccol{\`o} and Chiara Gigli and Margherita Giampieri and Gabriele Viviani and Claudio Poggioni and Luigi Padeletti",
year = "2015",
month = "12",
day = "1",
doi = "10.1097/MEJ.0000000000000130",
language = "English",
volume = "22",
pages = "162--169",
journal = "European Journal of Emergency Medicine",
issn = "0969-9546",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

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 -