Hypertension and atrial fibrillation: prognostic aspects of troponin elevations in clinical practice.
BACKGROUND
Hypertension and atrial fibrillation (AFib) frequently coexist in clinical practice. However, it is unclear whether this association per se or in combination with coronary artery disease (CAD) is a predictor of adverse outcomes.


OBJECTIVE
The aim of this study is to recognize and treat CAD in patients with hypertension and AFib.


METHODS
Patients with long-standing hypertension and recent-onset AFib (lasting ≤48 hours) were enrolled and managed with standard care regardless of the presence of troponin elevations (e-TnI) (group 1, n=636, 2010-2011 years) or managed with tailored-care including echocardiography and stress testing when presenting with e-TnI (group 2, n=663, 2012-2013 years).


METHODS
The composite of ischemic vascular events including stroke, acute coronary syndrome, revascularization, and death at the 6-month follow-up.


RESULTS
Out of 1299 patients enrolled, those with e-TnI (56 and 57 in groups 2 and 1, respectively, P=0.768) were more likely to admit in group 2 vs. group 1 (21 vs. 32, respectively, P=0.060), and less likely to undergo stress testing in group 2 vs. group 1 (15 vs. 1, respectively, P<0.001). Twenty-one patients in group 2 were admitted with positive stress testing (n=9) or high e-TnI (n=12; 1.04±1.98 ng/mL); conversely 35 were discharged with negative stress testing (n=6) or very-low e-TnI (n=29; 0.27±0.22 ng/mL). Finally, 7 patients vs. 1, in groups 2 and 1, respectively, underwent revascularization (P=0.032), and 3 vs. 12 reached the endpoint (P=0.024). On multivariate analysis, e-TnI, known CAD and age were predictors of the endpoint.


CONCLUSIONS
In patients with hypertension, AFib, and e-TnI, tailored-care inclusive of echocardiography and stress testing succeeded in recognizing and treating CAD avoiding adverse events without increase in admissions.
From the *Atrial Fibrillation Outpatient Clinic and Emergency Medicine, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy; and †Dysrhytmias Unit, Department of Cardiology; Careggi University Hospital, Florence, Italy.
Alberto
A
Conti
Andrea
A
Alesi
Federica
F
Trausi
Margherita
M
Scorpiniti
Elena
E
Angeli
Sofia
S
Bigiarini
Simone
S
Bianchi
Chiara
C
Donnini
Delia
D
Lazzeretti
Luigi
L
Padeletti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006801:Humans; D006973:Hypertension / Q000097:blood*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*
D019210:Troponin I