Key result
Elevated cardiac troponin in ED patients with AFib is linked to ~170% higher mortality.
Why the study?
The prognostic value of cardiac troponin in patients with atrial fibrillation admitted to an emergency department remains inconclusive.
Does elevated cardiac troponin predict mortality and major adverse cardiac events in adult patients with atrial fibrillation admitted to the emergency department?
Meta-Analysis (n=5,750)
Does elevated cardiac troponin predict mortality and major adverse cardiac events in adult patients with atrial fibrillation admitted to the emergency department?
Hazard Ratio: 2.7 (95% CI 1.55–4.72)
p-value: p=<0.001
Elevated cardiac troponin is a strong prognostic marker for increased mortality and major adverse cardiac events in patients presenting to the emergency department with atrial fibrillation.
May inform ED risk stratification in AF; confirms prognostic association but leaves open management impact.
INTRODUCTION: Elevated levels of cardiac troponin (cTn) indicate underlying heart disease and is known to predict adverse events in multiple conditions. Its role in atrial fibrillation (AF) in the acute setting is still not conclusive. We aimed to assess the prognostic value of c-Tn in patients with AF admitted to an emergency department (ED). METHODS: Systematic searches were conducted using PubMed and the Cochrane Library and the International Clinical Trials Registry Platform to identify studies from year 2009 to October 2019 reporting on the prognostic value of cTn on all-cause mortality or major adverse cardiac events (MACE) in adult patients with AF in the ED. We pooled hazard ratio (HR) and 95% confidence interval (CI) using fixed and random effects models according the heterogeneity. We planned to conduct a sensitivity and subgroup analyses. RESULTS: Five studies involving 5750 patients were identified. The mean follow-up ranged from 12 to 35 months. An increase in mortality was observed in the elevated cTn group compared to the controls, HR=2.7 (95% CI 1.55-4.72), P for effect<0.001, I2=80%). For MACE, the pooled HR was 2.17 (95%CI 1.60-2.94), P for effect<0.001, I2=0%). In the subgroup analysis we found no significant difference in type of troponin used and study design. CONCLUSIONS: The elevation of cardiac troponin was significantly associated with higher mortality and major adverse cardiac events in patients with AF admitted to an ED. In this setting the use of c-Tn could provide prognostic information.
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A 2020 study conducted a meta-analysis in Atrial Fibrillation (n=5,750). Elevated cardiac troponin vs. Controls was evaluated on All-cause mortality (HR 2.7, 95% CI 1.55-4.72, p=<0.001). Elevated cardiac troponin in patients with atrial fibrillation admitted to the emergency department was associated with increased mortality (HR 2.7; 95% CI 1.55-4.72; P<0.001).
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