TY - JOUR
T1 - Elevated troponin levels in patients with atrial tachyarrhythmias
AU - Rozenbaum, Zach
AU - Sapir, Orly
AU - Taieb, Philippe
AU - Ziv-Baran, Tomer
AU - Konigstein, Maayan
AU - Hochstadt, Aviram
AU - Rosso, Raphael
AU - Banai, Shmuel
AU - Chorin, Ehud
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Objective Data regarding the significance of elevated troponin in the setting of atrial tachyarrhythmia remain inconclusive. In the present study, we aimed to explore the discriminative ability of troponin for obstructive coronary artery disease (CAD) among patients with atrial tachyarrhythmias. Methods We retrospectively identified patients with atrial tachyarrhythmias and elevated serum troponin levels, who underwent invasive coronary angiography during the same admission. The prevalence of obstructive CAD among these patients was compared to that of historically matched patients who underwent coronary angiography due to suspected non-ST elevation myocardial infarction and had no arrhythmias. Results Overall 318 patients with suspected non-ST elevation myocardial infarction were analyzed (n = 159 with atrial tachyarrhythmias and n = 159 without arrhythmias). Obstructive CAD was detected in 39% of patients with an arrhythmia compared to 85.5% in the control group (P < 0.001). A multivariable analysis demonstrated that parameters associated with obstructive CAD among patient with atrial tachyarrhythmias and elevated troponin were diabetes mellitus [odds ratio (OR) 2.7, 95% confidence interval (CI) 1.23-5.91, P = 0.013], prior ischemic heart disease (OR 4.48, 95% CI 1.93-10.4, P < 0.001) and troponin level (OR 3.18 for every 1000 ng/L increment, 95% CI 1.85-5.48, P < 0.001). Conclusions Elevated troponin is not a reliable indicator for the presence of underlying obstructive CAD among patients who present with atrial tachyarrhythmias. Risk stratification of these patients should rely on the degree of troponin elevation, and the presence of diabetes mellitus and prior ischemic heart disease.
AB - Objective Data regarding the significance of elevated troponin in the setting of atrial tachyarrhythmia remain inconclusive. In the present study, we aimed to explore the discriminative ability of troponin for obstructive coronary artery disease (CAD) among patients with atrial tachyarrhythmias. Methods We retrospectively identified patients with atrial tachyarrhythmias and elevated serum troponin levels, who underwent invasive coronary angiography during the same admission. The prevalence of obstructive CAD among these patients was compared to that of historically matched patients who underwent coronary angiography due to suspected non-ST elevation myocardial infarction and had no arrhythmias. Results Overall 318 patients with suspected non-ST elevation myocardial infarction were analyzed (n = 159 with atrial tachyarrhythmias and n = 159 without arrhythmias). Obstructive CAD was detected in 39% of patients with an arrhythmia compared to 85.5% in the control group (P < 0.001). A multivariable analysis demonstrated that parameters associated with obstructive CAD among patient with atrial tachyarrhythmias and elevated troponin were diabetes mellitus [odds ratio (OR) 2.7, 95% confidence interval (CI) 1.23-5.91, P = 0.013], prior ischemic heart disease (OR 4.48, 95% CI 1.93-10.4, P < 0.001) and troponin level (OR 3.18 for every 1000 ng/L increment, 95% CI 1.85-5.48, P < 0.001). Conclusions Elevated troponin is not a reliable indicator for the presence of underlying obstructive CAD among patients who present with atrial tachyarrhythmias. Risk stratification of these patients should rely on the degree of troponin elevation, and the presence of diabetes mellitus and prior ischemic heart disease.
KW - atrial fibrillation
KW - atrial tachyarrhythmias
KW - coronary artery disease
KW - troponin
UR - http://www.scopus.com/inward/record.url?scp=85087532232&partnerID=8YFLogxK
U2 - 10.1097/MCA.0000000000000912
DO - 10.1097/MCA.0000000000000912
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C2 - 32452884
AN - SCOPUS:85087532232
SN - 0954-6928
VL - 31
SP - 451
EP - 457
JO - Coronary Artery Disease
JF - Coronary Artery Disease
IS - 5
ER -