Predictors of significant coronary artery disease in atrial fibrillation: are cardiac troponins a useful measure

Alghamry, Alaa, Hanna, Joseph, Pelecanos, Anita, Kyranis, Stephen, Khelgi, Vinod, O'Rourke, Peter, Carroll, Oran, Oxenford, Cassie, Rangaswamaiah, Swetha and Tan, Christopher (2016) Predictors of significant coronary artery disease in atrial fibrillation: are cardiac troponins a useful measure. International Journal of Cardiology, 223 744-749. doi:10.1016/j.ijcard.2016.08.267

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Author Alghamry, Alaa
Hanna, Joseph
Pelecanos, Anita
Kyranis, Stephen
Khelgi, Vinod
O'Rourke, Peter
Carroll, Oran
Oxenford, Cassie
Rangaswamaiah, Swetha
Tan, Christopher
Title Predictors of significant coronary artery disease in atrial fibrillation: are cardiac troponins a useful measure
Journal name International Journal of Cardiology   Check publisher's open access policy
ISSN 1874-1754
Publication date 2016-11-15
Sub-type Article (original research)
DOI 10.1016/j.ijcard.2016.08.267
Open Access Status File (Author Post-print)
Volume 223
Start page 744
End page 749
Total pages 6
Place of publication E Park, Shannon, Clare Ireland
Publisher Elsevier Ireland
Collection year 2017
Language eng
Formatted abstract
Background: Cardiac Troponin I (cTnI) is frequently measured in patients presenting with symptomatic atrial fibrillation (AF). The significance of elevated cTnI levels in this patient cohort is unclear. We investigated the value of cTnI elevation in this setting and whether it is predictive for significant coronary artery disease (sCAD).

Methods: We conducted a retrospective, single-center, case–control study of 231 patients who presented with symptomatic AF to The Prince Charles Hospital emergency department, Brisbane, Australia between 2006 and 2014. Patients who underwent serial cTnI testing and assessment for CAD were included. Clinical variables that are known to predict CAD and could potentially predict cTnI elevation were collected. Binary logistic regression was performed to identify predictors of sCAD and cTnI elevation.

Results: Cardiac Troponin I elevation above standard cut off was not predictive for sCAD after adjustment for other predictors (OR 1.62, 95% CI 0.79–3.32. p = 0.19). However, the highest cTnI concentration value (cTnI peak) was predictive for sCAD (OR 2.02, 95% CI 1.02–3.97, p = 0.04). Dyspnea on presentation (OR 4.52, 95% CI 1.87–10.91, p = 0.001), known coronary artery disease (OR 3.44, 95% CI 1.42–8.32, p = 0.006), and ST depression on the initial electrocardiogram (OR 2.57, 95% CI 1.11–5.97, p = 0.028) predicted sCAD in our cohort, while heart rate on initial presentation was inversely correlated with sCAD (OR 0.99, 95% CI 0.971–1.00, p = 0.034).

Conclusion: Troponin elevation is common in patients presenting to hospital with acute symptomatic AF and it is not a reliable indicator for underlying sCAD in this patient cohort. However, cTnI peak was a predictor of significant coronary artery disease.
Keyword Acute coronary syndrome
Atrial fibrillation
Coronary artery disease
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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