Catheter ablation for atrial fibrillation significantly reduced the risk of future acute coronary syndrome compared to antiarrhythmic medications (HR 0.20).
Cohort (n=2,344)
No
Does catheter ablation for atrial fibrillation reduce the risk of future acute coronary syndrome compared to antiarrhythmic medications or no AF?
Catheter ablation for atrial fibrillation is associated with a significantly reduced long-term risk of future acute coronary syndrome compared to medical therapy, and the CHA2DS2-VASc score strongly predicts this risk.
Effect estimate: HR 0.20 (95% CI 0.13-0.30)
Absolute Event Rate: 0.15% vs 0.78%
p-value: p=<0.001
It remains unknown whether catheter ablation for atrial fibrillation (AF) reduces future acute coronary syndrome (ACS) risk or whether the CHA2DS2-VASc score has a role in predicting this risk. We aimed to compare very long-term risk of ACS between patients who received catheter ablation to AF or antiarrhythmic medications and controls without AF. Propensity scores were calculated for each patient and used to assemble a cohort of 787 patients undergoing AF ablation in 2003–2012. Patients were compared to an equal number of AF patients treated with antiarrhythmic medications and a control group without AF. Patients with previous coronary events were excluded. The primary endpoint was ACS occurrence. Baseline clinical characteristics were comparable. After a mean 9.1 ± 3.2-year follow-up, the ablation group had lower incidence of new onset ACS than the medication and non-AF control groups (annual incidence: 0.15%. 0.78%, and 0.35%; with 2.67, 4.16, and 10.44 cases/1000 person-years, respectively; P < 0.001). After adjusting for multiple confounders, the ablation group had lower future ACS risk than the medication (hazard ratio HR: 0.20, 95% confidence interval CI: 0.13–0.30) and control groups (HR: 0.30, 95% CI: 0.20–0.45). The CHA2DS2-VASc score was a strong predictor of ACS (HR: 1.61, 95% CI: 1.47–1.76; AUC: 85.9%, 95% CI: 78.5–93.2%). A baseline CHA2DS2-VASc score ≥ 4 predicted future ACS (positive predictive rate: 14.3%). This study suggested that catheter ablation for AF may be beneficial to reduce future ACS risk in AF patients, and a high baseline CHA2DS2-VASc score can predict future acute coronary events.
Chou et al. (Sun,) conducted a cohort in Atrial fibrillation (n=2,344). Catheter ablation vs. Antiarrhythmic medications was evaluated on Occurrence of acute coronary syndrome (HR 0.20, 95% CI 0.13-0.30, p=<0.001). Catheter ablation for atrial fibrillation significantly reduced the risk of future acute coronary syndrome compared to antiarrhythmic medications (HR 0.20).