Association between troponin and outcome in patients with chest pain and rapid atrial fibrillation: a retrospective study of a single-center 10-year cohort
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Association between troponin and outcome in patients with chest pain and rapid atrial fibrillation: a retrospective study of a single-center 10-year cohort. / García, Ana; Miota, Natalia; Miró, Òscar; López-Ayala, Pedro; López-Barbeito, Beatriz; Strebel, Ivo; Xipell, Carolina; Fuenzalida, Carolina; Martínez-Nadal, Gemma; Boeddinghaus, Jasper; Nestelberger, Thomas; Twerenbold, Raphael; Mueller, Christian; Coll-Vinent, Blanca.
In: EUR J EMERG MED, Vol. 29, No. 6, 01.12.2022, p. 404-412.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Association between troponin and outcome in patients with chest pain and rapid atrial fibrillation: a retrospective study of a single-center 10-year cohort
AU - García, Ana
AU - Miota, Natalia
AU - Miró, Òscar
AU - López-Ayala, Pedro
AU - López-Barbeito, Beatriz
AU - Strebel, Ivo
AU - Xipell, Carolina
AU - Fuenzalida, Carolina
AU - Martínez-Nadal, Gemma
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Twerenbold, Raphael
AU - Mueller, Christian
AU - Coll-Vinent, Blanca
N1 - Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - BACKGROUND AND OBJECTIVE: The prognosis of myocardial infarction in patients with rapid atrial fibrillation (RAF) is poorly known. We sought to ascertain if troponin concentrations are associated with a higher risk of major adverse cardiovascular events (MACE) in patients with RAF and chest discomfort suggestive of coronary origin.METHODS: We retrospectively reviewed all consecutive patients attending an emergency department of a single-center (2008-2017) with chest pain suggestive of coronary origin who had RAF and at least one troponin determination. Patients were classified as having normal/increased troponin. They were followed until December 2019 to detect MACE (primary outcome), which included acute coronary syndrome (ACS), revascularization, stroke, or all-cause death. In addition to cardiovascular death and type I myocardial infarction, these were considered secondary outcomes. The adjusted risk was determined by Cox regression, and sensitivity analysis were run. Relationship between troponin as a continuous variable and outcomes was also evaluated, as well as interaction by sex.RESULTS: We included 574 patients (median = 76.5 years, IQR = 14, women 56.8%, increased troponin 34.1%) followed by a median of 3.8 years (IQR = 4.8). MACE occurred in 200 patients (34.8%). Increased troponin was independently associated with MACE (adjusted hazard ratio, 1.502, 95% CI, 1.130-1.998), ACS (adjusted hazard ratio, 2.488, 95% CI, 1.256-4.928), type I myocardial infarction (adjusted hazard ratio, 2.771, 95% CI, 1.212-6.333) and stroke (adjusted hazard ratio, 3.580, 95% CI, 1.888-6.787) but not with death, cardiovascular death or revascularization. Sensitivity analyses were consistent with these results. There was no interaction by sex. When assessed continuously, an increase in troponin concentrations was lineally associated with a steady increase in the risk of MACE.CONCLUSIONS: In patients with RAF who complain of chest pain, increased troponin levels are related to adverse cardiovascular outcomes.
AB - BACKGROUND AND OBJECTIVE: The prognosis of myocardial infarction in patients with rapid atrial fibrillation (RAF) is poorly known. We sought to ascertain if troponin concentrations are associated with a higher risk of major adverse cardiovascular events (MACE) in patients with RAF and chest discomfort suggestive of coronary origin.METHODS: We retrospectively reviewed all consecutive patients attending an emergency department of a single-center (2008-2017) with chest pain suggestive of coronary origin who had RAF and at least one troponin determination. Patients were classified as having normal/increased troponin. They were followed until December 2019 to detect MACE (primary outcome), which included acute coronary syndrome (ACS), revascularization, stroke, or all-cause death. In addition to cardiovascular death and type I myocardial infarction, these were considered secondary outcomes. The adjusted risk was determined by Cox regression, and sensitivity analysis were run. Relationship between troponin as a continuous variable and outcomes was also evaluated, as well as interaction by sex.RESULTS: We included 574 patients (median = 76.5 years, IQR = 14, women 56.8%, increased troponin 34.1%) followed by a median of 3.8 years (IQR = 4.8). MACE occurred in 200 patients (34.8%). Increased troponin was independently associated with MACE (adjusted hazard ratio, 1.502, 95% CI, 1.130-1.998), ACS (adjusted hazard ratio, 2.488, 95% CI, 1.256-4.928), type I myocardial infarction (adjusted hazard ratio, 2.771, 95% CI, 1.212-6.333) and stroke (adjusted hazard ratio, 3.580, 95% CI, 1.888-6.787) but not with death, cardiovascular death or revascularization. Sensitivity analyses were consistent with these results. There was no interaction by sex. When assessed continuously, an increase in troponin concentrations was lineally associated with a steady increase in the risk of MACE.CONCLUSIONS: In patients with RAF who complain of chest pain, increased troponin levels are related to adverse cardiovascular outcomes.
KW - Female
KW - Humans
KW - Acute Coronary Syndrome/complications
KW - Atrial Fibrillation/complications
KW - Chest Pain/diagnosis
KW - Emergency Service, Hospital
KW - Myocardial Infarction/diagnosis
KW - Retrospective Studies
KW - Risk Assessment
KW - Stroke
KW - Troponin
KW - Male
KW - Aged
U2 - 10.1097/MEJ.0000000000000945
DO - 10.1097/MEJ.0000000000000945
M3 - SCORING: Journal article
C2 - 35579514
VL - 29
SP - 404
EP - 412
JO - EUR J EMERG MED
JF - EUR J EMERG MED
SN - 0969-9546
IS - 6
ER -