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Can Biomarkers Predict Causes of Death in AF?

Circulation; ePub 2018 Jun 5; Sharma, et al

In patients with atrial fibrillation (AF), biomarkers are a strong predictor of cause-specific death and may improve the ability to discriminate among patients’ risks for different causes of death, a recent study suggests. The ARISTOTLE randomized 18,201 patients with AF to apixaban or warfarin. Biomarkers were measured at randomization in 14,798 patients with 1.9 years median follow-up. Researchers found:

  • 1,272 patients died: 652 (51%) cardiovascular (CV); 32 (3%) bleeding; and 588 (46%) non-CV/non-bleeding deaths.
  • Among CV-deaths, 255 (39%) were sudden cardiac deaths, 168 (26%) heart failure (HF), and 106 stroke/systemic embolism (SE) (16%) deaths.
  • Biomarkers were the strongest predictors of cause-specific death: a doubling of troponin-T was most strongly associated with sudden death (HR, 1.48), NT-proBNP with HF death (HR, 1.62), and GDF-15 with bleeding death (HR, 1.72).
  • Prior stroke/SE followed by troponin-T were the most predictive for stroke/SE death.


Sharma A, Hijazi Z, Andersson U, et al. The use of biomarkers to predict specific causes of death in patients with atrial fibrillation: Insights from the ARISTOTLE trial. [Published online ahead of print June 5, 2018]. doi:10.1161/CIRCULATIONAHA.118.034125.

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