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High-sensitivity troponin T and risk stratification in patients with atrial fibrillation during treatment with apixaban or warfarin.

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Hijazi, Z; Wallentin, L; Siegbahn, A; Andersson, U; Alexander, JH; Atar, D; Gersh, BJ; Hanna, M; Harjola, VP; Horowitz, JD; Husted, S ...
Published in: J Am Coll Cardiol
January 7, 2014

OBJECTIVES: The aim of this study was to evaluate the prognostic value of high-sensitivity troponin T (hs-TnT) in addition to clinical risk factors and the CHA2DS2VASc (congestive heart failure, hypertension, 75 years of age and older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, 65 to 74 years of age, female) risk score in patients with atrial fibrillation (AF). BACKGROUND: The level of troponin is a powerful predictor of cardiovascular events and mortality. METHODS: A total of 14,897 patients with AF were randomized to treatment with apixaban or warfarin in the ARISTOTLE (Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation) trial. The associations between baseline hs-TnT levels and outcomes were evaluated using adjusted Cox regression models. RESULTS: Levels of hs-TnT were measurable in 93.5% of patients; 75% had levels >7.5 ng/l, 50% had levels >11.0 ng/l, and 25% had levels >16.7 ng/l. During a median 1.9-year period, the annual rates of stroke or systemic embolism ranged from 0.87% in the lowest hs-TnT quartile to 2.13% in the highest hs-TnT quartile (adjusted hazard ratio [HR]: 1.94; 95% confidence interval [CI]: 1.35 to 2.78; p = 0.0010). The annual rates in the corresponding groups ranged from 0.46% to 4.24% (adjusted HR: 4.31; 95% CI: 2.91 to 6.37; p < 0.0001) for cardiac death and from 1.26% to 4.21% (adjusted HR: 1.91; 95% CI: 1.43 to 2.56; p = 0.0001) for major bleeding. Adding hs-TnT levels to the CHA2DS2VASc score improved the C statistic from 0.620 to 0.635 for stroke or systemic embolism (p = 0.0226), from 0.592 to 0.711 for cardiac death (p < 0.0001), and from 0.591 to 0.629 for major bleeding (p < 0.0001). Apixaban reduced rates of stroke, mortality, and bleeding regardless of the hs-TnT level. CONCLUSIONS: Levels of hs-TnT are often elevated in patients with AF. The hs-TnT level is independently associated with an increased risk of stroke, cardiac death, and major bleeding and improves risk stratification beyond the CHA2DS2VASc risk score. The benefits of apixaban as compared with warfarin are consistent regardless of the hs-TnT level. (Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation [ARISTOTLE]; NCT00412984).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 7, 2014

Volume

63

Issue

1

Start / End Page

52 / 61

Location

United States

Related Subject Headings

  • Warfarin
  • United States
  • Troponin T
  • Survival Rate
  • Stroke
  • Risk Assessment
  • Pyridones
  • Pyrazoles
  • Prognosis
  • Middle Aged
 

Citation

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Hijazi, Z., Wallentin, L., Siegbahn, A., Andersson, U., Alexander, J. H., Atar, D., … ARISTOTLE Investigators. (2014). High-sensitivity troponin T and risk stratification in patients with atrial fibrillation during treatment with apixaban or warfarin. In J Am Coll Cardiol (Vol. 63, pp. 52–61). United States. https://doi.org/10.1016/j.jacc.2013.07.093
Hijazi, Ziad, Lars Wallentin, Agneta Siegbahn, Ulrika Andersson, John H. Alexander, Dan Atar, Bernard J. Gersh, et al. “High-sensitivity troponin T and risk stratification in patients with atrial fibrillation during treatment with apixaban or warfarin.” In J Am Coll Cardiol, 63:52–61, 2014. https://doi.org/10.1016/j.jacc.2013.07.093.
Hijazi Z, Wallentin L, Siegbahn A, Andersson U, Alexander JH, Atar D, et al. High-sensitivity troponin T and risk stratification in patients with atrial fibrillation during treatment with apixaban or warfarin. In: J Am Coll Cardiol. 2014. p. 52–61.
Hijazi, Ziad, et al. “High-sensitivity troponin T and risk stratification in patients with atrial fibrillation during treatment with apixaban or warfarin.J Am Coll Cardiol, vol. 63, no. 1, 2014, pp. 52–61. Pubmed, doi:10.1016/j.jacc.2013.07.093.
Hijazi Z, Wallentin L, Siegbahn A, Andersson U, Alexander JH, Atar D, Gersh BJ, Hanna M, Harjola VP, Horowitz JD, Husted S, Hylek EM, Lopes RD, McMurray JJV, Granger CB, ARISTOTLE Investigators. High-sensitivity troponin T and risk stratification in patients with atrial fibrillation during treatment with apixaban or warfarin. J Am Coll Cardiol. 2014. p. 52–61.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 7, 2014

Volume

63

Issue

1

Start / End Page

52 / 61

Location

United States

Related Subject Headings

  • Warfarin
  • United States
  • Troponin T
  • Survival Rate
  • Stroke
  • Risk Assessment
  • Pyridones
  • Pyrazoles
  • Prognosis
  • Middle Aged