Impact of underlying coronary artery disease on the presentation symptoms and in-hospital outcome of patients with atrial fibrillation

Abstract

Objectives: Underlying coronary artery disease (CAD) is an established risk factor for the development of Atrial Fibrillation (AF). How underlying CAD affects symptoms and outcome of patients presenting with AF remains unknown. The aim of the current study was to evaluate how patients with established CAD as evidenced by a history of old myocardial infarction (OMI) differ in symptoms and outcome when hospitalized with AF in a real-world population. Methods: Retrospective analysis of prospective registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made. Patients were divided into two groups according to history of OMI on presentation. Clinical characteristics, symptoms of presentation and outcome were analyzed. Results: During the 20-years period, 3850 patients were hospitalized for AF; 417 (10.8%) had OMI on presentation while 3433 (89.2%) had no OMI. OMI patients were 11 years older, had more prevalence of hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease and had lower mean left ventricular ejection fraction on echocardiography (all, P value =0.001). Patients with OMI were significantly less likely to present with palpitations (25.7% versus 47.1%) and more likely to present with shortness of breath (36.9% vs. 26.7%) and chest pain (21.3% vs. 10.5%) compared to non-OMI patients (all, P value =0.001) [table]. The in-hospital mortality rate was significantly higher in patients with OMI (8.6% versus 3.6%; P value =0.001). Conclusions: Our study demonstrates that underlying CAD significantly affects the presentation symptoms and outcome of AF patients.