Key result
Atrial tachyarrhythmia with troponin elevation linked to ~47 percentage points lower obstructive CAD than NSTEMI.
Why the study?
Data regarding the significance of elevated troponin in the setting of atrial tachyarrhythmia were inconclusive, motivating an evaluation of its discriminative ability for obstructive CAD.
Does the presence of atrial tachyarrhythmias affect the prevalence of obstructive coronary artery disease in patients presenting with elevated troponin undergoing coronary angiography?
Cohort (n=318)
Does the presence of atrial tachyarrhythmias affect the prevalence of obstructive coronary artery disease in patients presenting with elevated troponin undergoing coronary angiography?
Elevated troponin is a poor standalone indicator of obstructive CAD in patients with atrial tachyarrhythmias (39% vs 85.5% in controls); risk stratification should incorporate diabetes, prior ischemic heart disease, and the magnitude of troponin elevation.
Answers are grounded in this paper and cite their sources.
Troponin elevation with atrial tachyarrhythmia may not indicate obstructive CAD; leaves open refined stratification incorporating comorbidities and troponin magnitude.
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.
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Rozenbaum et al. (2020) conducted a cohort in Suspected non-ST elevation myocardial infarction with or without atrial tachyarrhythmias and elevated troponin (n=318). Atrial tachyarrhythmias with elevated serum troponin levels vs. Historically matched patients with suspected non-ST elevation myocardial infarction and no arrhythmias was evaluated on Prevalence of obstructive coronary artery disease (CAD) on invasive coronary angiography (p=<0.001). Atrial tachyarrhythmia with elevated troponin was associated with a lower prevalence of obstructive CAD than suspected NSTEMI without arrhythmia (39% vs 85.5%, P<0.001).
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