Troponin-T, NT-proBNP May Predict Mortality Risk in Atrial Fibrillation

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The troponin-T biomarker demonstrated the strongest association with sudden death in patients with atrial fibrillation.
The troponin-T biomarker demonstrated the strongest association with sudden death in patients with atrial fibrillation.

Troponin-T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and growth differentiation factor-15 (GDF-15) represented important cardiac biomarkers that may offer value for predicting the risk of bleeding and mortality in patients with atrial fibrillation (AF), according to a study published in Circulation.

In this secondary analysis of the double-blind Apixaban for the Prevention of Stroke in Subjects with Atrial Fibrillation (ARISTOTLE; ClinicalTrials.gov Identifier: NCT00412984) trial, researchers sought to determine associations between changes in cardiac biomarkers with mortality and bleeding events.

A total of 14,798 patients with AF who received either apixaban or warfarin from the ARISTOTLE trial were included in the analysis. At baseline, patients had ≥1 CHADS2 risk factor for systemic embolism (SE) or stroke and also presented with one or more of four cardiac biomarkers, including troponin-T, NT-proBNP, GDF-15, and interleukin-6.

The primary end point for the analysis was cause-specific cardiovascular death, which included sudden cardiac death, heart failure death, and stroke/SE death.

Mortality occurred in 7.3% (n=1075) of patients in the cohort with available biomarker data. Patients randomly assigned to apixaban had a significantly lower risk for stroke and SE-related mortality compared with patients assigned to warfarin (39 vs 67; hazard ratio [HR], 0.58; 95% CI, 0.39-0.86; P =.005).

In terms of clinical variables, a history of heart failure was linked to an increased risk for cardiovascular death (adjusted HR, 2.05; 95% CI, 1.74-2.42; P <.0001), heart failure death (HR, 2.89; 95% CI, 2.09-3.99; P <.0001), and sudden cardiac death (HR, 2.32; 95% CI, 1.64-3.28; P <.0001). In addition, a history of stroke/SE was associated with stroke/SE-related death (HR, 2.66, 95% CI, 1.79-3.95; P <.0001).

A doubling of the troponin-T biomarker demonstrated the strongest association with sudden death in patients with AF (HR, 1.48; P <.001). In addition, GDF-15 and NT-proBNP were most associated with bleeding-related death (HR, 1.72; P =.028) and heart failure death (HR, 1.62; P <.001), respectively.

The post hoc analysis investigators suggested that the patient population of this trial may not be representative of other patients with AF receiving anticoagulation therapy.

Cardiac biomarkers, including troponin-T, NT-proBNP, GDF-15, and interleukin-6, may be useful for guiding therapies focused “on the prevention of other fatal events ... and targeting treatment and prevention of cardiac risk factors such as heart failure that might improve survival of these patients.”

Disclosures: Several authors report financial relationships with pharmaceutical companies, including AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Roche, and others.

Reference

Sharma A, Hijazi Z, Andersson U, et al. The use of biomarkers to predict specific causes of death in patients with atrial fibrillation: insights from the ARISTOTLE trial [published online June 5, 2018]. Circulation. doi: 10.1161/CIRCULATIONAHA.118.034125

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