Association between troponin and outcome in patients with chest pain and rapid atrial fibrillation: a retrospective study of a single-center 10-year cohort.

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.

Association between acute heart failure and major cardiovascular events in atrial fibrillation patients presenting at the emergency department: an EMERG-AF ancillary study.

BACKGROUND: There is little evidence concerning the impact of acute heart failure (AHF) on the prognosis of atrial fibrillation patients attending the emergency department (ED). OBJECTIVE: To know the influence of AHF on adverse long-term outcomes in patients presenting with atrial fibrillation in ED. DESIGN, SETTING AND PARTICIPANTS: Secondary analysis of a prospective, multicenter, observational cohort of consecutive atrial fibrillation patients, performed in 62 Spanish EDs. EXPOSURE: Patients presenting with atrial fibrillation in ED were divided by the presence or absence of AHF at arrival. OUTCOME MEASURES AND ANALYSIS: Primary outcome: combination of 1-year all-cause mortality, major bleeding, stroke and other major cardiovascular events (MACE). Secondary outcomes: each of these events analyzed separately. Cox and logistic regression were used to investigate adjusted significant associations between AHF and outcomes. MAIN RESULTS: Totally, 1107 consecutive ED patients with atrial fibrillation attending ED were analyzed, 262 (23.7%) with AHF. The primary outcome occurred in 433 patients (39.1%), 1-year all-cause mortality in 151 patients (13.6%), major bleeding in 47 patients (4.2 %), stroke in 31 patients (2.8 %) and other MACE in 333 patients (30.1%). AHF was independently related to the primary outcome [odds ratio (OR), 1.422; 95% confidence interval (CI), 1.020-1.981; P = 0.037)] and 1-year MACE (OR, 1.797; 95% CI, 1.285-2.512; P = 0.001), but not to 1-year all-cause mortality, stroke or bleeding. CONCLUSIONS: The coexistence of AHF in patients presenting with atrial fibrillation in ED is associated to a worse 1-year outcome mainly due to MACE, but does not impact in overall mortality.