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Comparative prediction of long-term mortality by the CHA2DS2-VASc score and cardiac troponin I levels in patients with atrial fibrillation at the emergency department

Published:April 14, 2020DOI:https://doi.org/10.1016/j.ejim.2020.04.021
      Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, and is associated with an increased risk of stroke, heart failure (HF) and mortality [
      • Schnabel R.B.
      • Yin X.
      • Gona P.
      • Larson M.G.
      • Beiser A.S.
      • McManus D.D.
      • et al.
      50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study.
      ]. In this regard, the CHA2DS2-VASc score is a well-known predictor of stroke in patients with AF, with some studies evaluating its use as a marker for predicting all-cause death [
      • Crandall M.A.
      • Horne B.D.
      • Day J.D.
      • Anderson J.L.
      • Muhlestein J.B.
      • Crandall B.G.
      • et al.
      Atrial fibrillation significantly increases total mortality and stroke risk beyond that conveyed by the CHADS2 risk factors.
      ,
      • Ntaios G.
      • Lip G.Y.H.
      • Makaritsis K.
      • Papavasileiou V.
      • Vemmou A.
      • Koroboki E.
      • et al.
      CHADS2, CHA2S2DS2-VASc, and long-term stroke outcome in patients without atrial fibrillation.
      . Cardiac troponin I (cTnI) has consistently provided prognostic information on the risk of stroke, vascular events and mortality in patients with AF [
      • Hijazi Z.
      • Oldgren J.
      • Andersson U.
      • Connolly S.J.
      • Ezekowitz M.D.
      • Hohnloser S.H.
      • et al.
      Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a randomized evaluation of long-term anticoagulation therapy (RE-LY) substudy.
      ]. However, it is not known whether the prognostic value of cTnI prevails or is better than the CHA2DS2-VASc score in patients attending the emergency department (ED) for a variety of reasons, but having documented AF on the admission electrocardiogram (ECG). Therefore, our study sought to determine the prognostic value of cTnI and the CHA2DS2-VASc score in predicting a 5-year all-cause mortality and readmission for HF or myocardial infarction (MI) in a cohort of unselected AF patients, attending the ED.

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