Atrial fibrillation is more frequently associated with non-obstructive coronary lesions: The Bialystok Coronary Project

INTRODUCTION: Atrial fibrillation (AF) and chronic coronary syndrome (CCS) share common risk factors and frequently coexist. Additionally, AF symptoms may mimic CCS. OBJECTIVES: The aim of the study was to investigate the hypothesis indicating absence of significant coronary lesions in patients with AF as compared with those with sinus rhythm. PATIENTS AND METHODS: We conducted a single‑center retrospective study including consecutive patients referred for elective coronary angiography between 2007 and 2016. RESULTS: The study population included 8288 patients out of whom 1674 had AF. There were substantial differences between groups with and without AF. Patients with AF were significantly older, more often were men and had diabetes, and more frequently were diagnosed with both chronic kidney disease and heart failure. On the other hand, they had history of hyperlipidemia less often. CCS was less frequently detected in patients with AF as compared with those with sinus rhythm (37.5% vs 41.1%; P <0.001). Additionally, the latter group more often underwent subsequent coronary angioplasty (19.2% vs 22.3%; P = 0.004). Multivariable analysis identified AF as an independent factor associated with absence of significant coronary lesions (odds ratio, 1.57; 95% CI, 1.32-1.87; P <0.001). Moreover, a comparison between patients with and without angiographically significant CCS revealed a higher prevalence of AF in the latter group (18.7% vs 21.2%; P = 0.006). CONCLUSIONS: In our study, AF was associated with the absence of significant coronary lesions on angiography, reflecting difficulties with qualifying patients with AF for invasive CCS diagnostic workup. Our findings suggest the need for more efficacious noninvasive diagnostic approach for patients with AF and suspected CCS.