Background and objective 

The prognosis of myocardial infarction in patients with rapid atrial fibrillation (RAF) is poorly known. We sought to ascertain if troponin concentrations are associated with a higher risk of major adverse cardiovascular events (MACE) in patients with RAF and chest discomfort suggestive of coronary origin.

Methods 

We retrospectively reviewed all consecutive patients attending an emergency department of a single-center (2008–2017) with chest pain suggestive of coronary origin who had RAF and at least one troponin determination. Patients were classified as having normal/increased troponin. They were followed until December 2019 to detect MACE (primary outcome), which included acute coronary syndrome (ACS), revascularization, stroke, or all-cause death. In addition to cardiovascular death and type I myocardial infarction, these were considered secondary outcomes. The adjusted risk was determined by Cox regression, and sensitivity analysis were run. Relationship between troponin as a continuous variable and outcomes was also evaluated, as well as interaction by sex.

Results 

We included 574 patients (median = 76.5 years, IQR = 14, women 56.8%, increased troponin 34.1%) followed by a median of 3.8 years (IQR = 4.8). MACE occurred in 200 patients (34.8%). Increased troponin was independently associated with MACE (adjusted hazard ratio, 1.502, 95% CI, 1.130–1.998), ACS (adjusted hazard ratio, 2.488, 95% CI, 1.256–4.928), type I myocardial infarction (adjusted hazard ratio, 2.771, 95% CI, 1.212–6.333) and stroke (adjusted hazard ratio, 3.580, 95% CI, 1.888–6.787) but not with death, cardiovascular death or revascularization. Sensitivity analyses were consistent with these results. There was no interaction by sex. When assessed continuously, an increase in troponin concentrations was lineally associated with a steady increase in the risk of MACE.

Conclusions 

In patients with RAF who complain of chest pain, increased troponin levels are related to adverse cardiovascular outcomes.

中文翻译：

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肌钙蛋白与胸痛和快速心房颤动患者预后之间的关联：单中心 10 年队列回顾性研究

背景和目标 

快速心房颤动（RAF）患者心肌梗死的预后知之甚少。我们试图确定肌钙蛋白浓度是否与 RAF 和提示冠状动脉起源的胸部不适患者发生主要不良心血管事件 (MACE) 的较高风险相关。

方法 

我们回顾性地回顾了单中心急诊科（2008-2017）所有因胸痛提示冠状动脉起源且进行 RAF 和至少一项肌钙蛋白测定的连续患者。患者被分类为肌钙蛋白正常/升高。对他们进行随访直至 2019 年 12 月，以检测 MACE（主要结局），其中包括急性冠脉综合征 (ACS)、血运重建、中风或全因死亡。除了心血管死亡和 I 型心肌梗死之外，这些都被认为是次要结局。通过 Cox 回归确定调整后的风险，并进行敏感性分析。还评估了肌钙蛋白作为连续变量与结果之间的关系以及性别之间的相互作用。

结果 

我们纳入了 574 名患者（中位年龄 = 76.5 岁，IQR = 14，女性 56.8%，肌钙蛋白升高34.1%），其次是中位年龄 3.8 年（IQR = 4.8）。200 名患者（34.8%）发生 MACE。肌钙蛋白增加与 MACE（调整后危险比，1.502，95% CI，1.130–1.998）、ACS（调整后危险比，2.488，95% CI，1.256–4.928）、I 型心肌梗死（调整后危险比，2.771）独立相关。 ，95% CI，1.212–6.333）和卒中（调整后风险比，3.580，95% CI，1.888–6.787），但与死亡、心血管死亡或血运重建无关。敏感性分析与这些结果一致。没有性别互动。连续评估时，肌钙蛋白浓度的增加与 MACE 风险的稳定增加呈线性相关。

结论 

在主诉胸痛的 RAF 患者中，肌钙蛋白水平升高与不良心血管结局相关。