title: Long-term prognostic value of dysglycemia and ischemic vascular disease beyond abnormal troponin levels in patients presenting acute atrial fibrillation.
abstract: BACKGROUND
  Prognostication beyond troponin levels in patients with acute atrial fibrillation (AF) is still unclear.
  
  
  METHODS
  One-month and 1-year outcomes in 1091 patients with acute AF were analyzed. Primary endpoints were stroke or the composite of acute coronary syndrome, revascularization, and death.
  
  
  RESULTS
  In the short term, troponin (odds ratio (OR) 15, 95% confidence interval (CI), 3.4-67.9, P < 0.001) and known ischemic heart disease (OR 5.83, 95% CI, 1.3-26.2, P = 0.021) were predictors of the composite endpoint, with multivariate analysis. No variables linked with stroke. In the long term, metabolic syndrome (OR 4.7, 95% CI, 1.2-18.3, P = 0.024) and age (OR 1.1, 95% CI, 1.0-1.1, P = 0.009) were predictors of stroke; metabolic syndrome (OR 4.3, 95% CI, 1.6-11.0, P = 0.003), known ischemic heart disease (OR 3.3, 95% CI, 1.7-6.4, P = 0.001), persistence of AF after the first-line approach (OR 2.2, 95% CI, 1.2-4.3, P = 0.018), and age (OR 1.0, 95% CI, 1.0-1.1, P = 0.025), but not troponin so were of the composite endpoint. In the short term, increased discriminative values in prognostication of the composite endpoint were observed with C-statistic when troponin was compared with dysglycemia (P = 0.032). No variables did better than others in the prognostication of stroke. In the long term, increased discriminative values in the prognostication of stroke were observed with C-statistic when age was compared with troponin (P = 0.020), ischemic heart disease (P = 0.025), and persistence of AF after the first-line approach (P = 0.049); so was for CHADS2 score ≥1 versus vascular disease (P = 0.038).
  
  
  CONCLUSIONS
  In patients with acute AF, abnormal troponin levels add prognostic value to clinical parameters in the short term; dysglycemia and known vascular disease in the long term.
authors: Emergency Medicine, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy. aaaconti@hotmail.com
authors: Alberto
authors: A
authors: Conti
authors: Yuri
authors: Y
authors: Mariannini
authors: Claudio
authors: C
authors: Poggioni
authors: Gabriele
authors: G
authors: Viviani
authors: Margherita
authors: M
authors: Luzzi
authors: Niccolò
authors: N
authors: De Bernardis
authors: Luigi
authors: L
authors: Padeletti
authors: Gian Franco
authors: GF
authors: Gensini
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D015415:Biomarkers; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D062606:Tertiary Care Centers; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I