Prognostic significance of troponin level in 3121 patients presenting with atrial fibrillation (The NIHR Health Informatics Collaborative TROP‐AF study)
Year: 2020
Type: article
Study design: Observational Study
Abstract: Background Patients presenting with atrial fibrillation ( AF ) often undergo a blood test to measure troponin, but interpretation of the result is impeded by uncertainty about its clinical importance. We investigated the relationship between troponin level, coronary angiography, and all‐cause mortality in real‐world patients presenting with AF . Methods and Results We used National Institute of Health Research Health Informatics Collaborative data to identify patients admitted between 2010 and 2017 at 5 tertiary centers in the United Kingdom with a primary diagnosis of AF . Peak troponin results were scaled as multiples of the upper limit of normal. A total of 3121 patients were included in the analysis. Over a median follow‐up of 1462 (interquartile range, 929–1975) days, there were 586 deaths (18.8%). The adjusted hazard ratio for mortality associated with a positive troponin (value above upper limit of normal) was 1.20 (95% CI , 1.01–1.43; P <0.05). Higher troponin levels were associated with higher risk of mortality, reaching a maximum hazard ratio of 2.6 (95% CI , 1.9–3.4) at ≈250 multiples of the upper limit of normal. There was an exponential relationship between higher troponin levels and increased odds of coronary angiography. The mortality risk was 36% lower in patients undergoing coronary angiography than in those who did not (adjusted hazard ratio, 0.61; 95% CI , 0.42–0.89; P =0.01). Conclusions Increased troponin was associated with increased risk of mortality in patients presenting with AF . The lower hazard ratio in patients undergoing invasive management raises the possibility that the clinical importance of troponin release in AF may be mediated by coronary artery disease, which may be responsive to revascularization.
Authors: Amit Kaura, Ahran D. Arnold, Vasileios Panoulas, Benjamin Glampson, Jim Davies, Abdulrahim Mulla, Kerrie Woods, Joe Omigie, Anoop D. Shah, Keith M. Channon, Jonathan N. Weber, Mark R. Thursz, Paul Elliott, Harry Hemingway, Bryan Williams, Folkert W. Asselbergs, Michael O'Sullivan, Graham M. Lord, Narbeh Melikian, David C. Lefroy, Darrel P. Francis, Ajay M. Shah, Rajesh Kharbanda, Divaka Perera, Riyaz S. Patel, Jamil Mayet
Institutions: Imperial College Healthcare NHS Trust, National Institute for Health and Care Research, NIHR Imperial Biomedical Research Centre, Imperial College London, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, King's College London, King's College Hospital NHS Foundation Trust, University College London Hospitals NHS Foundation Trust, UCL Biomedical Research Centre, University College London, Health Data Research UK, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, NIHR Cambridge Biomedical Research Centre, Universität Ulm, Guy's and St Thomas' NHS Foundation Trust, University of Manchester
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,750
Awards: NIHR Senior Investigator Award, The NIHR-BHF Cardiovascular Partnership, Centre for Health service and Academic Partnership in Translational eHealth Research (CHAPTER), G3327974904, Improving the quality of care of patients with angina and heart attack, UK Health Informatics Research Network, G3933260129, Centre for Health service and Academic Partnership in Translational eHealth Research (CHAPTER), NIHR Senior Investigator Award, G5896616042, Genetic and phenotypic risk factors for subsequent coronary heart disease events, G7640241099, NIHR Senior Investigator Award
OpenAlex ID: W3013696503