Emergency Medicine, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy.
Am J Emerg Med. 2013 Apr;31(4):699-704. doi: 10.1016/j.ajem.2012.12.031. Epub 2013 Feb 8.
The link between minor troponin (cardiac troponin I [cTnI]) elevations and atrial fibrillation (AF) is still debated.
A total of 948 patients with AF lasting less than 48 hours participated in the study and were required to undergo 1-month and 12-month follow-up. The exclusion criteria were represented by younger than 18 years, the presence of hemodynamic instability, or severe comorbidity. Primary end point was the composite of ischemic vascular events inclusive of stroke, acute coronary syndrome, revascularization, and death.
In the short term, 4 patients (5%) of 78 with abnormal cTnI reached the primary end point (P = .001 vs others). Conversely, in the long term, 13 patients (17%) with abnormal cTnI, 21 (10%) with known ischemic vascular disease, and 50 (5%) aged patients (75 ± 10 years) reached the primary end point (P < .001, P < .001, and P = .002, respectively). At multivariate analysis, abnormal cTnI (hazard ratio [HR], 2.84; 95% confidence interval, 1.38-5.84; P = .005), known ischemic vascular disease (HR, 2.03; 95% confidence interval, 1.11-3.70; P = .021), and age (HR, 1.05; 95 confidence interval, 1.02-1.08; P = .002) were predictors of the primary end point. Minimal or minor cTnI elevation (<0.45 or ≥ 0.45 ng/mL, respectively) showed no differences when associated with the primary end point. The C-statistic demonstrated the significant prognostic value of older age and known ischemic vascular disease, beyond troponin. Clinical parameters inclusive of heart rate, blood pressure, and risk factors for arteriosclerosis showed no relationship with adverse events. Readmission rate did not differ between groups.
In patients with acute AF, minor cTnI elevations link to short-term adverse events. Known ischemic vascular disease and older age showed prognostic value only in the long term.
心肌肌钙蛋白 I（cTnI）轻度升高与心房颤动（AF）之间的关系仍存在争议。
共有 948 名持续时间小于 48 小时的 AF 患者参与了这项研究，并需要进行 1 个月和 12 个月的随访。排除标准为年龄小于 18 岁、存在血流动力学不稳定或严重合并症。主要终点是包括卒中、急性冠状动脉综合征、血运重建和死亡在内的缺血性血管事件的复合终点。
在短期内，4 名（5%）cTnI 异常的患者达到了主要终点（P=0.001 比其他患者）。相反，在长期随访中，13 名（17%）cTnI 异常的患者、21 名（10%）已知缺血性血管疾病的患者和 50 名（5%）年龄较大的患者（75±10 岁）达到了主要终点（P＜0.001、P＜0.001 和 P=0.002）。多变量分析显示，cTnI 异常（危险比[HR]，2.84；95%置信区间，1.38-5.84；P=0.005）、已知缺血性血管疾病（HR，2.03；95%置信区间，1.11-3.70；P=0.021）和年龄（HR，1.05；95%置信区间，1.02-1.08；P=0.002）是主要终点的预测因素。轻度或轻微的 cTnI 升高（分别＜0.45 或≥0.45ng/mL）与主要终点无差异。C 统计量显示，年龄较大和已知缺血性血管疾病除了肌钙蛋白外，还有显著的预后价值。包括心率、血压和动脉粥样硬化危险因素在内的临床参数与不良事件无相关性。两组再入院率无差异。
在急性 AF 患者中，轻微的 cTnI 升高与短期不良事件相关。已知的缺血性血管疾病和年龄较大仅在长期随访中具有预后价值。
