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 journalArticlepeer-review

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

Keywords

  • atrial fibrillation
  • cardiac biomarkers
  • coronary artery disease
  • emergency medicine
  • prognosis
  • risk assessment

ASJC Scopus subject areas

  • Emergency Medicine

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