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Long-term prognostic value of dysglycemia and ischemic vascular disease beyond abnormal troponin levels in patients presenting acute atrial fibrillation.
Crit Pathw Cardiol. 2013 Mar;12(1):14-23
Authors: Conti A, Mariannini Y, Poggioni C, Viviani G, Luzzi M, De Bernardis N, Padeletti L, Gensini GF
Abstract
BACKGROUND: Prognostication beyond troponin levels in patients with acute atrial fibrillation (AF) is still unclear.
METHODS: One-month and 1-year outcomes in 1091 patients with acute AF were analyzed. Primary endpoints were stroke or the composite of acute coronary syndrome, revascularization, and death.
RESULTS: In the short term, troponin (odds ratio (OR) 15, 95% confidence interval (CI), 3.4-67.9, P < 0.001) and known ischemic heart disease (OR 5.83, 95% CI, 1.3-26.2, P = 0.021) were predictors of the composite endpoint, with multivariate analysis. No variables linked with stroke. In the long term, metabolic syndrome (OR 4.7, 95% CI, 1.2-18.3, P = 0.024) and age (OR 1.1, 95% CI, 1.0-1.1, P = 0.009) were predictors of stroke; metabolic syndrome (OR 4.3, 95% CI, 1.6-11.0, P = 0.003), known ischemic heart disease (OR 3.3, 95% CI, 1.7-6.4, P = 0.001), persistence of AF after the first-line approach (OR 2.2, 95% CI, 1.2-4.3, P = 0.018), and age (OR 1.0, 95% CI, 1.0-1.1, P = 0.025), but not troponin so were of the composite endpoint. In the short term, increased discriminative values in prognostication of the composite endpoint were observed with C-statistic when troponin was compared with dysglycemia (P = 0.032). No variables did better than others in the prognostication of stroke. In the long term, increased discriminative values in the prognostication of stroke were observed with C-statistic when age was compared with troponin (P = 0.020), ischemic heart disease (P = 0.025), and persistence of AF after the first-line approach (P = 0.049); so was for CHADS2 score ≥1 versus vascular disease (P = 0.038).
CONCLUSIONS: In patients with acute AF, abnormal troponin levels add prognostic value to clinical parameters in the short term; dysglycemia and known vascular disease in the long term.
PMID: 23411603 [PubMed - indexed for MEDLINE]