Prognostic significance of troponin level in 3121 patients presenting with atrial fibrillation (The NIHR Health Informatics Collaborative TROP-AF study)
BackgroundPatients presenting with atrial fibrillation (AF) often undergo a blood test to measure troponin, but interpretation of the result is impeded by uncertainty about its clinical importance. We investigated the relationship between troponin level, coronary angiography, and all‐cause mortality...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Wiley Open Access
2020
|
| _version_ | 1797050811357855744 |
|---|---|
| author | Kaura, A Arnold, AD Panoulas, V Glampson, B Davies, J Mulla, A Woods, K Omigie, J Shah, AD Channon, KM Weber, JN Thursz, MR Elliott, P Hemingway, H Williams, B Asselbergs, FW O'Sullivan, M Lord, GM Melikian, N Lefroy, DC Francis, DP Shah, AM Kharbanda, R Perera, D Patel, RS Mayet, J |
| author_facet | Kaura, A Arnold, AD Panoulas, V Glampson, B Davies, J Mulla, A Woods, K Omigie, J Shah, AD Channon, KM Weber, JN Thursz, MR Elliott, P Hemingway, H Williams, B Asselbergs, FW O'Sullivan, M Lord, GM Melikian, N Lefroy, DC Francis, DP Shah, AM Kharbanda, R Perera, D Patel, RS Mayet, J |
| author_sort | Kaura, A |
| collection | OXFORD |
| description | BackgroundPatients presenting with atrial fibrillation (AF) often undergo a blood test to measure troponin, but interpretation of the result is impeded by uncertainty about its clinical importance. We investigated the relationship between troponin level, coronary angiography, and all‐cause mortality in real‐world patients presenting with AF.
Methods and ResultsWe used National Institute of Health Research Health Informatics Collaborative data to identify patients admitted between 2010 and 2017 at 5 tertiary centers in the United Kingdom with a primary diagnosis of AF. Peak troponin results were scaled as multiples of the upper limit of normal. A total of 3121 patients were included in the analysis. Over a median follow‐up of 1462 (interquartile range, 929–1975) days, there were 586 deaths (18.8%). The adjusted hazard ratio for mortality associated with a positive troponin (value above upper limit of normal) was 1.20 (95% CI, 1.01–1.43; P<0.05). Higher troponin levels were associated with higher risk of mortality, reaching a maximum hazard ratio of 2.6 (95% CI, 1.9–3.4) at ≈250 multiples of the upper limit of normal. There was an exponential relationship between higher troponin levels and increased odds of coronary angiography. The mortality risk was 36% lower in patients undergoing coronary angiography than in those who did not (adjusted hazard ratio, 0.61; 95% CI, 0.42–0.89; P=0.01).
ConclusionsIncreased troponin was associated with increased risk of mortality in patients presenting with AF. The lower hazard ratio in patients undergoing invasive management raises the possibility that the clinical importance of troponin release in AF may be mediated by coronary artery disease, which may be responsive to revascularization. |
| first_indexed | 2024-03-06T18:10:43Z |
| format | Journal article |
| id | oxford-uuid:02e72fc7-b405-4fc1-96d5-074c27a11c76 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T18:10:43Z |
| publishDate | 2020 |
| publisher | Wiley Open Access |
| record_format | dspace |
| spelling | oxford-uuid:02e72fc7-b405-4fc1-96d5-074c27a11c762022-03-26T08:43:26ZPrognostic significance of troponin level in 3121 patients presenting with atrial fibrillation (The NIHR Health Informatics Collaborative TROP-AF study)Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:02e72fc7-b405-4fc1-96d5-074c27a11c76EnglishSymplectic ElementsWiley Open Access2020Kaura, AArnold, ADPanoulas, VGlampson, BDavies, JMulla, AWoods, KOmigie, JShah, ADChannon, KMWeber, JNThursz, MRElliott, PHemingway, HWilliams, BAsselbergs, FWO'Sullivan, MLord, GMMelikian, NLefroy, DCFrancis, DPShah, AMKharbanda, RPerera, DPatel, RSMayet, JBackgroundPatients presenting with atrial fibrillation (AF) often undergo a blood test to measure troponin, but interpretation of the result is impeded by uncertainty about its clinical importance. We investigated the relationship between troponin level, coronary angiography, and all‐cause mortality in real‐world patients presenting with AF. Methods and ResultsWe used National Institute of Health Research Health Informatics Collaborative data to identify patients admitted between 2010 and 2017 at 5 tertiary centers in the United Kingdom with a primary diagnosis of AF. Peak troponin results were scaled as multiples of the upper limit of normal. A total of 3121 patients were included in the analysis. Over a median follow‐up of 1462 (interquartile range, 929–1975) days, there were 586 deaths (18.8%). The adjusted hazard ratio for mortality associated with a positive troponin (value above upper limit of normal) was 1.20 (95% CI, 1.01–1.43; P<0.05). Higher troponin levels were associated with higher risk of mortality, reaching a maximum hazard ratio of 2.6 (95% CI, 1.9–3.4) at ≈250 multiples of the upper limit of normal. There was an exponential relationship between higher troponin levels and increased odds of coronary angiography. The mortality risk was 36% lower in patients undergoing coronary angiography than in those who did not (adjusted hazard ratio, 0.61; 95% CI, 0.42–0.89; P=0.01). ConclusionsIncreased troponin was associated with increased risk of mortality in patients presenting with AF. The lower hazard ratio in patients undergoing invasive management raises the possibility that the clinical importance of troponin release in AF may be mediated by coronary artery disease, which may be responsive to revascularization. |
| spellingShingle | Kaura, A Arnold, AD Panoulas, V Glampson, B Davies, J Mulla, A Woods, K Omigie, J Shah, AD Channon, KM Weber, JN Thursz, MR Elliott, P Hemingway, H Williams, B Asselbergs, FW O'Sullivan, M Lord, GM Melikian, N Lefroy, DC Francis, DP Shah, AM Kharbanda, R Perera, D Patel, RS Mayet, J Prognostic significance of troponin level in 3121 patients presenting with atrial fibrillation (The NIHR Health Informatics Collaborative TROP-AF study) |
| title | Prognostic significance of troponin level in 3121 patients presenting with atrial fibrillation (The NIHR Health Informatics Collaborative TROP-AF study) |
| title_full | Prognostic significance of troponin level in 3121 patients presenting with atrial fibrillation (The NIHR Health Informatics Collaborative TROP-AF study) |
| title_fullStr | Prognostic significance of troponin level in 3121 patients presenting with atrial fibrillation (The NIHR Health Informatics Collaborative TROP-AF study) |
| title_full_unstemmed | Prognostic significance of troponin level in 3121 patients presenting with atrial fibrillation (The NIHR Health Informatics Collaborative TROP-AF study) |
| title_short | Prognostic significance of troponin level in 3121 patients presenting with atrial fibrillation (The NIHR Health Informatics Collaborative TROP-AF study) |
| title_sort | prognostic significance of troponin level in 3121 patients presenting with atrial fibrillation the nihr health informatics collaborative trop af study |
| work_keys_str_mv | AT kauraa prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT arnoldad prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT panoulasv prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT glampsonb prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT daviesj prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT mullaa prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT woodsk prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT omigiej prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT shahad prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT channonkm prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT weberjn prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT thurszmr prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT elliottp prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT hemingwayh prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT williamsb prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT asselbergsfw prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT osullivanm prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT lordgm prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT melikiann prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT lefroydc prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT francisdp prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT shaham prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT kharbandar prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT pererad prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT patelrs prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy AT mayetj prognosticsignificanceoftroponinlevelin3121patientspresentingwithatrialfibrillationthenihrhealthinformaticscollaborativetropafstudy |