Fast Five Quiz: Atrial Fibrillation and Acute Coronary Syndrome

Sandeep K. Goyal, MD


March 10, 2022

Figure 3. Illustration depicting various elements related to acute coronary syndrome: a man in cardiac distress, the heart with coronary artery undergoing stent placement, an ECG, and aspirin.

As shown in the RE-LY trial, plasma biomarker measurements, in particular the cardiac biomarkers NT-proBNP and troponin, can improve risk prediction in patients with AF both in the presence or absence of left ventricular hypertrophy. Overall, these biomarkers remained independently associated with cardiovascular outcomes after adjustment for information on left ventricular hypertrophy status. Conversely, left ventricular hypertrophy did not remain an independent predictor for stroke or mortality after adjustment for the cardiac biomarkers NT-proBNP and troponin. Hence, in patients with AF, cardiac biomarkers were able to further identify patients with lower or higher risk both in the presence and in the absence of left ventricular hypertrophy, as indicated by ECG.

Patients who present in the emergency department with AF in the setting of rapid ventricular rate often report palpitations and symptoms of left ventricular dysfunction, such as shortness of breath and exercise intolerance. Troponin without ischemic injury may be detected in these patients because of a supply and demand mismatch. According to the Third Universal Definition of Myocardial Infarction consensus document, these supply and demand mismatch conditions should not be considered an MI but should instead be characterized as myocardial injury. Controlling the rapid ventricular rate can reveal the underlying disease and whether the patient is on the ACS continuum of care.

Learn more about risk management in patients with AF.


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