Aims In patients with atrial fibrillation, minor troponin I elevation is regularly detected; however, the prognostic significance of this finding is unknown. We therefore sought to examine the prognostic value of elevated troponin I in patients with atrial fibrillation. Methods and results A prospective study was conducted analysing all consecutive patients admitted with atrial fibrillation in a 2-year period. Patients with an ST-elevation myocardial infarction (MI) were excluded. Minor troponin elevation was defined as a troponin I level between 0.15 and 0.65 ng/mL, which is still below the 99th percentile of the upper reference limit. A positive troponin I was defined as >0.65 ng/mL. Study outcomes were all-cause mortality (death), death and myocardial infarction (death/MI), or all major adverse cardiac events (MACE: death, MI, or revascularization). A total of 407 patients were eligible for inclusion. The median duration of follow-up was 688 days. A minor elevation occurred in 81 (20) patients and 77 (19) had a positive troponin I. In a multivariate model, minor troponin I elevation and a positive troponin I were independently associated with death [hazard ratio (HR): 2.36, 95 confidence interval (CI): 1.174.73 for minor elevation and HR: 3.77, 95 CI: 1.4210.02 for positive troponin I]. Also, there was an independent correlation between the combined endpoints of death/MI and MACE and both a minor elevation and a positive troponin I. Conclusion Minor elevations in troponin I on hospital admission are associated with mortality and cardiac events in patients with atrial fibrillation and might be useful for risk stratification.

Atrial fibrillation, Prognosis, Troponin I,
European Heart Journal
Erasmus MC: University Medical Center Rotterdam

van den Bos, E.J, Constantinescu, A.A, van Domburg, R.T, Akin, S, Jordaens, L.J.L.M, & Kofflard, M.J.M. (2011). Minor elevations in troponin i are associated with mortality and adverse cardiac events in patients with atrial fibrillation. European Heart Journal, 32(5), 611–617. doi:10.1093/eurheartj/ehq491