Cardiac troponin and adverse outcomes in atrial fibrillation: A meta-analysis.

BACKGROUND

The prognostic value of cardiac troponin elevation in atrial fibrillation (AF) is unclear.

OBJECTIVE

To investigate the association of cardiac troponin elevation with adverse outcomes in AF by conducting a meta-analysis.

METHODS

We systematically searched the PubMed and Embase databases until April 2017 for studies assessing the association of cardiac troponin-T (cTnT) or troponin-I (cTnI) elevation with adverse outcomes in AF. The outcome measures were all-cause mortality and major adverse cardiac events (MACEs: death, stroke, myocardial infarction, pulmonary embolism, major bleeding, or revascularization).

RESULTS

Six studies involving 22,697 AF patients were identified. Meta-analysis showed that AF with elevated cardiac troponin was independently associated with increased risk of all-cause mortality (HR 2.04; 95% CI 1.56-2.67) and MACEs (HR 1.93; 95% CI 1.61-2.30). Furthermore, the prognostic value of cardiac troponin elevation was consistently found irrespective of method determination, type of troponin measured, sample size, and study quality subgroup.

CONCLUSIONS

AF with cardiac troponin elevation was independently associated with increased risk of all-cause mortality and MACEs. Therefore, determination of troponin should be considered for risk stratification in AF.