High Sensitivity Troponin I for Risk Assessment in Patients with Atrial Fibrillation: Insights from the ARISTOTLE Trial.

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High Sensitivity Troponin I for Risk Assessment in Patients with Atrial Fibrillation: Insights from the ARISTOTLE Trial.

Circulation. 2013 Nov 13;

Authors: Hijazi Z, Siegbahn A, Andersson U, Granger CB, Alexander JH, Atar D, Gersh BJ, Mohan P, Harjola VP, Horowitz J, Husted S, Hylek EM, Lopes RD, McMurray JJ, Wallentin L, on behalf of the ARISTOTLE Investigators

Abstract
BACKGROUND: High sensitivity troponin-I (hs-TnI) measurements improves risk assessment for cardiovascular events in many clinical settings, the added value in atrial fibrillation (AF) patients has not been described.
METHODS AND RESULTS: At randomization hs-TnI was analyzed in 14,821 AF patients in the ARISTOTLE trial comparing apixaban with warfarin. The associations between hs-TnI concentrations and clinical outcomes were evaluated using adjusted Cox analysis. The hs-TnI assay detected troponin (≥1.3 ng/L) in 98.5% patients, 50% had levels >5.4, 25% levels >10.1, and 9.2% levels ≥23 ng/L (the 99th percentile in healthy). During median 1.9 years follow-up annual rates of stroke or systemic embolism ranged from 0.76% in the lowest hs-TnI quartile to 2.26% in the highest quartile (>10.1ng/L). In multivariable analysis hs-TnI was significantly associated with stroke or systemic embolism, adjusted hazard ratio (HR) 1.98 (1.42-2.78), p=0.0007. hs-TnI was also significantly associated with cardiac death; annual rates ranged from 0.40% to 4.24%, HR 4.52 (3.05-6.70), p<0.0001, in the corresponding groups, and for major bleeding HR 1.44 (1.11-1.86), p=0.0250. Adding hs-TnI levels to the CHA2DS2VASc-score improved C-statistics from 0.629 to 0.653 for stroke or systemic embolism, and from 0.591 to 0.731 for cardiac death. There were no significant interactions with study treatment.
CONCLUSIONS: Troponin-I is detected in 98.5% and elevated in 9.2% of AF patients. The hs-TnI level is independently associated with a raised risk of stroke, cardiac death, and major bleeding and improves risk stratification beyond the CHA2DS2VASc-score. The benefits of apixaban as compared with warfarin are consistent regardless of hs-TnI levels.
CLINICAL TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov. Identifier: NCT00412984.

PMID: 24226808 [PubMed - as supplied by publisher]

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