Open AccessClinical Utility and Prognostic Significance of Measuring Troponin I Levels in Patients Presenting to the Emergency Room With Atrial Fibrillation
Author(s) -
Gupta Kamal,
Pillarisetti Jayasree,
Biria Mazda,
Pescetto Micah,
AbuSalah Tareq M.,
Annapureddy Chandra,
Ryschon Kay,
Dawn Buddhadeb,
Lakkireddy Dhanunjaya
Publication year - 2014
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22251
Subject(s) - medicine , atrial fibrillation , troponin , myocardial infarction , emergency department , cardiology , incidence (geometry) , clinical endpoint , clinical significance , troponin i , coronary artery disease , randomized controlled trial , physics , psychiatry , optics
Background The clinical significance of mildly elevated troponins in patients presenting to the emergency room (ER) with atrial fibrillation (AF) is not well understood. Hypothesis We hypothesized that mildly elevated troponin in these patients is associated with adverse cardiovascular outcomes. Methods In a multi‐center, retrospective study, 662 patients with AF were divided into 3 groups based on troponin levels: group 1, mildly elevated; group 2, normal; and group 3, troponin not measured. Primary outcome was the combined endpoint of all‐cause mortality and myocardial infarction (MI) at one year. Results Levels of TnI were measured in 503 (76%) patients. They were elevated in 220 patients (33%, group 1; mean, 0.56 ng/ mL ), normal in 283 patients (43%, group 2), and not measured in 159 patients (24%, group 3). Significantly more cardiac testing was done at index hospitalization in group 1 (50%) compared with groups 2 and 3 (28% and 29%, P ≤ 0.001) and in the following year (29%, vs 20% and 17%, P = 0.02). Group 1 had more positive tests (62%) compared with groups 2 and 3 (25% and 43%, P ≤ 0.001). Group 1 had a significantly higher occurrence of the primary endpoint (22%, vs 10% and 15%, P = 0.002), driven primarily by a higher incidence of MI in group 1 (7%, vs 1% and 2%, P = 0.001). Conclusions Troponin levels are routinely checked in a majority of patients presenting to the emergency department with AF . Even mildly elevated TnI is associated with a greater incidence of coronary artery disease on diagnostic testing and a higher 1‐year incidence of MI .