High Sensitivity Troponin I for Risk Assessment in Patients with Atrial Fibrillation: Insights from the ARISTOTLE Trial

CIRCULATIONAHA: November 13, 2013

Background—High sensitivity troponin-I (hs-TnI) measurements improves risk assessment for cardiovascular events in many clinical settings, the added value in atrial fibrillation (AF) patients has not been described.

Methods and Results—At randomization hs-TnI was analyzed in 14,821 AF patients in the ARISTOTLE trial comparing apixaban with warfarin. The associations between hs-TnI concentrations and clinical outcomes were evaluated using adjusted Cox analysis. The hs-TnI assay detected troponin (≥1.3 ng/L) in 98.5% patients, 50% had levels >5.4, 25% levels >10.1, and 9.2% levels ≥23 ng/L (the 99th percentile in healthy). During median 1.9 years follow-up annual rates of stroke or systemic embolism ranged from 0.76% in the lowest hs-TnI quartile to 2.26% in the highest quartile (>10.1ng/L). In multivariable analysis hs-TnI was significantly associated with stroke or systemic embolism, adjusted hazard ratio (HR) 1.98 (1.42-2.78), p=0.0007. Read More