High Sensitivity Troponin T and Risk Stratification in Patients with Atrial Fibrillation during Treatment with Apixaban or Warfarin.

Link to article at PubMed

High Sensitivity Troponin T and Risk Stratification in Patients with Atrial Fibrillation during Treatment with Apixaban or Warfarin.

J Am Coll Cardiol. 2013 Sep 19;

Authors: Hijazi Z, Wallentin L, Siegbahn A, Andersson U, Alexander JH, Atar D, Gersh BJ, Hanna M, Harjola VP, Horowitz JD, Husted S, Hylek EM, Lopes RD, McMurray JJ, Granger CB, ARISTOTLE Investigators

Abstract
OBJECTIVE: Evaluate the prognostic value of high-sensitivity troponin T (hs-TnT) in addition to clinical risk factors and the CHA2DS2VASc risk score in patients with atrial fibrillation (AF).
BACKGROUND: Troponin is a powerful predictor of cardiovascular events and mortality.
METHODS: 14,897 patients with AF randomized to apixaban or warfarin in the ARISTOTLE trial. The associations between baseline hs-TnT concentrations and outcomes were evaluated using adjusted Cox regression models.
RESULTS: hs-TnT was measurable in 99% of patients; 75% had levels above 7.5 ng/L, 50% above 11.0 ng/L and 25% above 16.7 ng/L. During 1.9 years the annual rates of stroke or systemic embolism ranged from 0.87% in the lowest to 2.13% in the highest hs-TnT quartile, adjusted hazard ratio (HR) 1.94 (1.35-2.78), p=0.0010. For cardiac death the annual rates in the corresponding groups ranged from 0.46% to 4.24%, adjusted HR 4.31 (2.91-6.37), p<0.0001 and for major bleeding from 1.26% to 4.21%, adjusted HR 1.91 (1.43-2.56), p=0.0001. Adding hs-TnT levels to the CHA2DS2VASc score improved the C-statistic from 0.620 to 0.635 (p=0.0226) for stroke or systemic embolism, from 0.592 to 0.711 for cardiac death (p<0.0001), and from 0.591 to 0.629 for major bleeding (p<0.0001). Apixaban reduced stroke, mortality, and bleeding regardless of the hs-TnT level.
CONCLUSIONS: Levels of hs-TnT are often elevated in patients with atrial fibrillation. The hs-TnT level is independently associated with a raised risk of stroke, cardiac death, and major bleeding and improves risk stratification beyond the CHA2DS2VASc risk score. The benefits of apixaban as compared with warfarin are consistent regardless of the hs-TnT level.

PMID: 24055845 [PubMed - as supplied by publisher]

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