title: Role of masked coronary heart disease in patients with recent-onset atrial fibrillation and troponin elevations.
abstract: BACKGROUND
  Patients with recent-onset atrial fibrillation (AF) and cardiac troponin I (cTnI) elevations show poor outcomes. Coronary heart disease might be a cause, consequence, or an innocent bystander.
  
  
  OBJECTIVE
  The aim of this study was to recognize and treat coronary heart disease to avoid adverse events.
  
  
  METHODS
  Patients with recent-onset AF participated in the study. The exclusion criteria were acute coronary syndrome and severe comorbidities. Patients managed with standard care (group 1, n=1086, years 2010-2011) were compared with patients managed with tailored care inclusive of echocardiography and stress testing when required (group 2, n=1055, years 2012-2013).
  
  
  METHODS
  The endpoint was a composite of ischemic vascular events including stroke, acute coronary syndrome, revascularization and cardiovascular death at 6 months of follow-up.
  
  
  RESULTS
  Of 4008 patients considered, 2141 were enrolled; 183 showed cTnI elevations, 92 in group 1 and 91 in group 2. cTnI elevations, known ischemic heart disease and age were predictors of the endpoint on multivariate analysis. Overall, two versus seven patients (P=0.033) in groups 1 and 2, respectively, underwent revascularization. Eventually, 16 patients in group 1 versus five patients in group 2 reached the endpoint (P=0.019). Patients of group 2 were managed as follow: 35 were admitted, 15 with positive stress testing and 20 with high cTnI values (mean values: 0.64±1.01 ng/ml). Fifty-six patients were discharged with negative stress testing results (n=13) or very low cTnI values (n=43, mean values 0.29±0.30 ng/ml).
  
  
  CONCLUSIONS
  In patients with AF and cTnI elevations, tailored care inclusive of echocardiography and stress testing succeeded in recognizing and treating masked 'critical' coronary heart disease, avoiding adverse events.
authors.affiliation: aAtrial Fibrillation Outpatient Clinic and Emergency Medicine bEmergency Medicine, Department of Critical Care Medicine and Surgery cDysrhytmias Unit, Department of Cardiology, University of Florence, Careggi University Hospital, Florence, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Conti
authors.forename: Yuri
authors.initials: Y
authors.lastname: Mariannini
authors.forename: Erica
authors.initials: E
authors.lastname: Canuti
authors.forename: Gabriele
authors.initials: G
authors.lastname: Cerini
authors.forename: Niccolò
authors.initials: N
authors.lastname: De Bernardis
authors.forename: Chiara
authors.initials: C
authors.lastname: Gigli
authors.forename: Margherita
authors.initials: M
authors.lastname: Giampieri
authors.forename: Gabriele
authors.initials: G
authors.lastname: Viviani
authors.forename: Claudio
authors.initials: C
authors.lastname: Poggioni
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications*; D016022:Case-Control Studies; D003327:Coronary Disease / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D019210:Troponin I / Q000097:blood*
chemical_list: D019210:Troponin I