Just quickly read through an abstract in Circulation (28th Feb 2012) published by Ziad et al, who performed a substudy analysis of the Randomised Evaluation of Long Term Anticoagulation Therapy (RE-LY) trial. While the original trial looked at Dabigatran Etixilate Vs Warfarin in management of patients with atrial fibrillation, the substudy published by Ziad's group analysed the prevalence of cardiac biomarkers Troponin I and NT-proBNP and their association with major cardiovascular events in atrial fibrillation.
After adjusting for other cardiovascular risk factors (as guided by the CHAD2 and CHA2DS2-VASc scoring system), they analysed biomarkers in 6189 patients. Patients with a higher troponin I level and NT-proBNP levels were at a higher risk of developing stroke when compared to those patients who had lower levels of these markers. A high troponin was defined as values >= 0.04microg/L and high NT-proBNP levels were defined as values >1402 ng/L. Vascular mortality rates showed a similar association. These results have shown that elevated troponin and NT-proBNP seen commonly in patients with atrial fibrillation are independently related to high risk of stroke and mortality. These would thus be useful for risk prediction.
So the question is - will these markers be eventually added to the risk scoring system to risk stratify patients and decide on anticoagulation treatment? Probably yes, but it appears a lot more research needs conducting.
Key messages for MRCP exam -
1. Remember the CHA2DS2-VASc score. In the choices if you see a high troponin level or elevated NT-proBNP level, these too are predictors of risk and should be considered based on this RE-LY substudy.
2. There is always a question or two regarding atrial fibrillation and anticoagulation - be it management of anticoagulation or management of bleeding secondary to anticoagulation. Know this well.
You can access the study at the following link - Ziad et al
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