Abstract
BackgroundIn standard reference sources, the incidence of coronary artery disease (CAD) in patients with atrial fibrillation (AF) ranged between 24 and 46.5%. Since then, the incidence of cardiovascular risk factors (CRF) has increased and modern treatment strategies (“pill in the pocket”) are only applicable to patients without structural heart disease. The aim of this study was to investigate the incidence and severity of CAD in patients with AF.MethodsFrom January 2005 until December 2009, we included 261 consecutive patients admitted to hospital with paroxysmal, persistent or permanent AF in this prospective study. All patients underwent coronary angiography and the Framingham risk score (FRS) was calculated. Patients with previously diagnosed or previously excluded CAD were excluded.ResultsThe overall incidence of CAD in patients presenting with AF was 34%; in patients >70 years, the incidence of CAD was 41%. The incidence of patients undergoing a percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) was 21%. Patients with CAD were older (73±8 years vs 68±10 years, p = 0.001), had significantly more frequent hypercholesterolemia (60% vs 30%, p<0.001), were more frequent smokers (26% vs 13%, p = 0.017) and suffered from angina more often (37% vs 2%, p<0.001). There was a significant linear trend among the FRS categories in percentage and the prevalence of CAD and PCI/CABG (p<0.0001).ConclusionsThe overall incidence of CAD in patients presenting with AF was relatively high at 34%; the incidence of PCI/CABG was 21%. Based upon increasing CRF in the western world, we recommend a careful investigation respecting the FRS to either definitely exclude or establish an early diagnosis of CAD – which could contribute to an early and safe therapeutic strategy considering type Ic antiarrhythmics and oral anticoagulation.
Highlights
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting 2.3 million individuals in the USA and 4.5 million people in the EU [1]
The Framingham study suggested that angina predisposed to atrial fibrillation (AF) and that the association of AF with coronary artery disease (CAD) was stronger in men [7]
A stable CAD was diagnosed in 34 patients (13%) and percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) was performed in 56 patients (21%)
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting 2.3 million individuals in the USA and 4.5 million people in the EU [1]. Common cardiovascular risk factors give support to associate coronary artery disease (CAD) and AF. The Framingham study suggested that angina predisposed to AF and that the association of AF with CAD was stronger in men [7]. The incidence of coronary artery disease (CAD) in patients with atrial fibrillation (AF) ranged between 24 and 46.5%. The incidence of cardiovascular risk factors (CRF) has increased and modern treatment strategies (‘‘pill in the pocket’’) are only applicable to patients without structural heart disease.
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