According to current guideline recommendations, the indication of OAC for men with a CHA₂DS₂-VASc-score of 1 point and women with 2 points is still unclear. It has been established that elevated levels of hsTnT occur in patients with non-coronary heart disease but the significance of hsTnT in this subgroup is not fully understood. The aim of this study is to evaluate the prognostic value of hsTnT in the prediction of mortality, stroke and severe bleeding for patients with atrial fibrillation.

In this retrospective study, we included 2843 patients with atrial fibrillation who were admitted in the Chest-Pain-Unit of the University Hospital Heidelberg from July 2017 to March 2020. The primary endpoints were mortality, stroke and severe bleeding after a follow-up time of a minimum of 365 days.

In the univariate analysis of all patients, elevated hsTnT > 14 ng/L was significantly associated with an increased rate of all three endpoints and was the strongest risk factor in the multivariate Cox regression (Figure 1). In the ROC analysis, hsTnT performed as well as the CHA₂DS₂-VASc-score in the prognosis of stroke (AUC 0.599 vs. 0.606, p=0.83) (Figure 2) and severe bleeding (AUC 0.626 vs. 0.582, p=0.09) while it outperformed the CHA₂DS₂-VASc-score in the prognosis of mortality (AUC 0.763 vs. 0.673, p<0.001).

Even in the subgroup (1P in men and 2P in women), elevated hsTnT levels were significantly associated with an increased rate of mortality and stroke. ROC analyses showed reasonable prognosis of mortality and stroke however the clinical relevance of these analyses is limited due to the very small number of events observed in the subgroup.

In conclusion, hsTnT gives additional information in the prognosis of mortality, stroke and severe bleeding in patients with atrial fibrillation. However, further studies need to be conducted to evaluate the prognostic value of hsTnT in patients with a CHA₂DS₂-VASc-score of 1 point in men and 2 points in women.