Imperial College London


Faculty of MedicineNational Heart & Lung Institute

Professor of Cardiology



+44 (0)20 7594 3381d.francis Website




Miss Juliet Holmes +44 (0)20 7594 5735




Block B Hammersmith HospitalHammersmith Campus






BibTex format

author = {Kaura, A and Arnold, AD and Vasileios, P and Glampson, B and Davies, J and Mulla, A and Woods, K and Omigie, J and Shah, AD and Channon, KM and Weber, JN and Thursz, MR and Elliott, P and Hemingway, H and Williams, B and Asselbergs, FW and OSullivan, M and Lord, GM and Melikian, N and Lefroy, DC and Francis, DP and Shah, AM and Kharbanda, R and Perera, D and Patel, RS and Mayet, J},
doi = {10.1161/JAHA.119.013684},
journal = {Journal of the American Heart Association},
title = {Prognostic significance of troponin level in 3,121 patients presenting with atrial fibrillation (The NIHR Health Informatics Collaborative TROP-AF study)},
url = {},
volume = {9},
year = {2020}

RIS format (EndNote, RefMan)

AB - Background-—Patients presenting with atrial fibrillation (AF) often undergo a blood test to measure troponin, but interpretation of theresult is impeded by uncertainty about its clinical importance. We investigated the relationship between troponin level, coronaryangiography, and all-cause mortality in real-world patients presenting with AF.Methods and Results-—We used National Institute of Health Research Health Informatics Collaborative data to identify patients admitted between 2010 and 2017 at 5 tertiary centers in the United Kingdom with a primary diagnosis of AF. Peak troponin results 7 were scaled as multiples of the upper limit of normal. A total of 3121 patients were included in the analysis. Over a median followup of 1462 (interquartile range, 929–1975) days, there were 586 deaths (18.8%). The adjusted hazard ratio for mortality associatedwith a positive troponin (value above upper limit of normal) was 1.20 (95% CI, 1.01–1.43; P<0.05). Higher troponin levels were associated with higher risk of mortality, reaching a maximum hazard ratio of 2.6 (95% CI, 1.9–3.4) at 250 multiples of the upper limit of normal. There was an exponential relationship between higher troponin levels and increased odds of coronary angiography.The mortality risk was 36% lower in patients undergoing coronary angiography than in those who did not (adjusted hazard ratio, 0.61; 95% CI, 0.42–0.89; P=0.01).Conclusions-—Increased troponin was associated with increased risk of mortality in patients presenting with AF. The lower hazard ratio in patients undergoing invasive management raises the possibility that the clinical importance of troponin release in AF may be mediated by coronary artery disease, which may be responsive to revascularization.
AU - Kaura,A
AU - Arnold,AD
AU - Vasileios,P
AU - Glampson,B
AU - Davies,J
AU - Mulla,A
AU - Woods,K
AU - Omigie,J
AU - Shah,AD
AU - Channon,KM
AU - Weber,JN
AU - Thursz,MR
AU - Elliott,P
AU - Hemingway,H
AU - Williams,B
AU - Asselbergs,FW
AU - OSullivan,M
AU - Lord,GM
AU - Melikian,N
AU - Lefroy,DC
AU - Francis,DP
AU - Shah,AM
AU - Kharbanda,R
AU - Perera,D
AU - Patel,RS
AU - Mayet,J
DO - 10.1161/JAHA.119.013684
PY - 2020///
SN - 2047-9980
TI - Prognostic significance of troponin level in 3,121 patients presenting with atrial fibrillation (The NIHR Health Informatics Collaborative TROP-AF study)
T2 - Journal of the American Heart Association
UR -
UR -
VL - 9
ER -