Scholars@Duke publication: Cardiac troponin is associated with cardiac outcomes in men and women with atrial fibrillation, insights from the ARISTOTLE trial.

Cardiac troponin is associated with cardiac outcomes in men and women with atrial fibrillation, insights from the ARISTOTLE trial.

Publication , Journal Article

Røsjø, H; Hijazi, Z; Omland, T; Westerbergh, J; Lyngbakken, MN; Alexander, JH; Gersh, BJ; Granger, CB; Hylek, EM; Lopes, RD; Siegbahn, A; Wallentin, L

Published in: J Intern Med

August 2020

Published version (DOI) Link to item

BACKGROUND: Cardiac troponin T (cTnT) and I (cTnI) concentrations provide strong prognostic information in anticoagulated patients with atrial fibrillation (AF). Whether the associations between cardiac troponin concentrations and mortality and morbidity differ by sex is not known. OBJECTIVES: To assess whether men and women have different concentrations and prognostic value of cTnT and cTnI measurements in anticoagulated patients with AF. METHODS: cTnT and cTnI concentrations were measured with high-sensitivity (hs) assays in EDTA plasma samples obtained from the multicentre ARISTOTLE trial, which randomized patients with AF and at least one risk factor for stroke or systemic embolic event to warfarin or apixaban. Patients were stratified according to sex and the associations between hs-troponin concentrations, and all-cause death, cardiac death, myocardial infarction, stroke or systemic embolic event and major bleeding were assessed in multivariable regression models. RESULTS: We found higher cardiac troponin concentrations in men (n = 9649) compared to women (n = 5331), both for hs-cTnT (median 11.8 [Q1-3 8.1-18.0] vs. 9.6 [6.7-14.3] ng L-1 , P < 0.001) and hs-cTnI (5.8 [3.4-10.8] vs. 4.9 [3.1-8.8] ng L-1 , P < 0.001). Adjusting for baseline demographics, comorbidities and medications, men still had significantly higher hs-troponin concentrations than women. C-reactive protein and N-terminal pro-B-type natriuretic peptide concentrations were higher in female patients. Both hs-cTnT and hs-cTnI concentrations were associated with all clinical outcomes similarly in men and women (p-value for interaction >0.05 for all end-points). CONCLUSION: Men have higher hs-troponin concentrations than women in AF. Regardless of sex, hs-troponin concentrations remain similarly associated with adverse clinical outcomes in anticoagulated patients with AF.

Duke Scholars

Author John Hunter Peel Alexander Medicine, Cardiology

Author Christopher Bull Granger Medicine, Cardiology

Author Renato Delascio Lopes Medicine, Cardiology

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Published In

J Intern Med

DOI

10.1111/joim.13072

EISSN

1365-2796

Publication Date

August 2020

Volume

288

Issue

Start / End Page

248 / 259

Location

England

Related Subject Headings

Troponin T
Troponin I
Stroke
Sex Factors
Prognosis
Peptide Fragments
Natriuretic Peptide, Brain
Myocardial Infarction
Male
Humans

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Røsjø, H., Hijazi, Z., Omland, T., Westerbergh, J., Lyngbakken, M. N., Alexander, J. H., … Wallentin, L. (2020). Cardiac troponin is associated with cardiac outcomes in men and women with atrial fibrillation, insights from the ARISTOTLE trial. J Intern Med, 288(2), 248–259. https://doi.org/10.1111/joim.13072

Røsjø, H., Z. Hijazi, T. Omland, J. Westerbergh, M. N. Lyngbakken, J. H. Alexander, B. J. Gersh, et al. “Cardiac troponin is associated with cardiac outcomes in men and women with atrial fibrillation, insights from the ARISTOTLE trial.” J Intern Med 288, no. 2 (August 2020): 248–59. https://doi.org/10.1111/joim.13072.

Røsjø H, Hijazi Z, Omland T, Westerbergh J, Lyngbakken MN, Alexander JH, et al. Cardiac troponin is associated with cardiac outcomes in men and women with atrial fibrillation, insights from the ARISTOTLE trial. J Intern Med. 2020 Aug;288(2):248–59.

Røsjø, H., et al. “Cardiac troponin is associated with cardiac outcomes in men and women with atrial fibrillation, insights from the ARISTOTLE trial.” J Intern Med, vol. 288, no. 2, Aug. 2020, pp. 248–59. Pubmed, doi:10.1111/joim.13072.

Røsjø H, Hijazi Z, Omland T, Westerbergh J, Lyngbakken MN, Alexander JH, Gersh BJ, Granger CB, Hylek EM, Lopes RD, Siegbahn A, Wallentin L. Cardiac troponin is associated with cardiac outcomes in men and women with atrial fibrillation, insights from the ARISTOTLE trial. J Intern Med. 2020 Aug;288(2):248–259.