Abstract P172: Association Of Atrial Fibrillation With Severity Of Coronary Artery Disease: The Emory Cardiovascular Biobank (emcab)

Abstract

Background: Existing literature suggests that atrial fibrillation (AF) can lead to coronary artery disease (CAD). However, little information exists regarding the association between AF and CAD severity. Methods: We conducted cross-sectional and prospective analyses of 7819 participants in the Emory Cardiovascular Biobank (EmCAB). EmCAB recruits patients undergoing cardiac catheterization at three Emory Healthcare hospitals in the Atlanta area. At enrollment, data on AF history and four CAD severity measurements were collected: presence of ≥70% coronary stenosis, presence of ≥50% coronary stenosis, number of vessels with ≥50% coronary stenosis, and the Gensini score. To minimize the effect of missing covariates, multiple imputation by chained equation (MICE) was employed. In the imputed dataset, linear, logistic, and Poisson models were used to examine the association between the different measurements and AF history. During follow-up, the occurrence of incident MI, fatal MI, and all-cause death were obtained as primary endpoints, and Cox regression models were used to examine the association of AF history with each endpoint. Results: At baseline, the prevalence of AF history was 8.5%. Among patients with and without AF history respectively, the prevalence of ≥50% stenosis was 72% and 76%, and of ≥70% stenosis was 65% and 70%, respectively. AF patients and non-AF patients had similar numbers of vessels with ≥50% stenosis on average (1.7, vs. 1.8) and a median Gensini score (10.0 vs. 10.5). No association was found between AF and the presence of ≥50% and ≥70% stenosis, and numbers of vessels with ≥50% stenosis. AF was associated with 3.32 (95% CI -7.20, 0.57) points lower Gensini score after multivariable adjustment (demographic and clinical factors). In the longitudinal analysis, there was no evidence of an association between AF and nonfatal MI, fatal MI, and any MI. The risk of all-cause mortality among AF patients was 1.66 times (95% CI 1.37, 2.01) that among non-AF patients in the unadjusted model and was strongly attenuated after adjustment for demographic and clinical factors (HR: 1.26, 95% CI 1.03, 1.53). Conclusion: In the EmCAB, AF was associated with all-cause mortality but not with CAD severity.