Minor elevations in troponin I are associated with mortality and adverse cardiac events in patients with atrial fibrillation

Eur Heart J. 2011 Mar;32(5):611-7. doi: 10.1093/eurheartj/ehq491. Epub 2011 Jan 20.


Aims: In patients with atrial fibrillation, minor troponin I elevation is regularly detected; however, the prognostic significance of this finding is unknown. We therefore sought to examine the prognostic value of elevated troponin I in patients with atrial fibrillation.

Methods and results: A prospective study was conducted analysing all consecutive patients admitted with atrial fibrillation in a 2-year period. Patients with an ST-elevation myocardial infarction (MI) were excluded. Minor troponin elevation was defined as a troponin I level between 0.15 and 0.65 ng/mL, which is still below the 99th percentile of the upper reference limit. A positive troponin I was defined as ≥ 0.65 ng/mL. Study outcomes were all-cause mortality (death), death and myocardial infarction (death/MI), or all major adverse cardiac events (MACE: death, MI, or revascularization). A total of 407 patients were eligible for inclusion. The median duration of follow-up was 688 days. A minor elevation occurred in 81 (20%) patients and 77 (19%) had a positive troponin I. In a multivariate model, minor troponin I elevation and a positive troponin I were independently associated with death [hazard ratio (HR): 2.36, 95% confidence interval (CI): 1.17-4.73 for minor elevation and HR: 3.77, 95% CI: 1.42-10.02 for positive troponin I]. Also, there was an independent correlation between the combined endpoints of death/MI and MACE and both a minor elevation and a positive troponin I.

Conclusion: Minor elevations in troponin I on hospital admission are associated with mortality and cardiac events in patients with atrial fibrillation and might be useful for risk stratification.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Atrial Fibrillation / metabolism
  • Atrial Fibrillation / mortality*
  • Biomarkers / metabolism
  • Cause of Death
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality
  • Myocardial Ischemia / mortality
  • Myocardial Revascularization / mortality
  • Prognosis
  • Prospective Studies
  • Risk Assessment
  • Troponin I / metabolism*


  • Biomarkers
  • Troponin I