Predicting Mortality in Patients with Atrial Fibrillation and Obstructive Chronic Coronary Syndrome: The Bialystok Coronary Project

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Suspected or confirmed obstructive chronic coronary syndrome and/or atrial fibrillation (n=7367). Intervention: Atrial fibrillation and/or obstructive chronic coronary syndrome vs. Patients without atrial fibrillation and/or without obstructive chronic coronary syndrome. Primary outcome: All-cause mortality associated with atrial fibrillation (HR 1.48, 95% CI 1.09-2.01).

Łukasz Kuźma; Anna Tomaszuk−Kazberuk; Anna Kurasz; Sławomir Dobrzycki; Marek Koziński; Bożena Sobkowicz; Gregory Y.H. Lip

doi:10.3390/jcm10214949

October 26, 2021Journal of Clinical MedicineOpen Access

Predicting Mortality in Patients with Atrial Fibrillation and Obstructive Chronic Coronary Syndrome: The Bialystok Coronary Project

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Key result

Atrial fibrillation and obstructive chronic coronary syndrome independently predicted long-term all-cause mortality in patients undergoing elective coronary angiography.

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Why the study?

With the prevalence of AF estimated to double over the coming decades, the authors aimed to investigate causes of long-term mortality in relation to AF and CCS.

Does the presence of atrial fibrillation and/or obstructive chronic coronary syndrome increase long-term all-cause and cardiovascular mortality in patients referred for elective coronary angiography?

Key Points

To investigate the causes and risk of long-term all-cause and cardiovascular mortality in patients diagnosed with atrial fibrillation and chronic coronary syndrome.
Analyzed 7367 consecutive patients referred for elective coronary angiography enrolled in a large single-centre retrospective registry, including 1484 with atrial fibrillation and 2881 with obstructive chronic coronary syndrome.
Tracked clinical outcomes over a median follow-up of 2029 days and identified independent predictors of all-cause and cardiovascular mortality using multivariate Cox proportional hazards models.
All-cause mortality was highest in AF(+)/CCS(+) patients (194/527 [36.8%]), followed by AF(+)/CCS(−) (210/957 [21.9%]) and AF(−)/CCS(+) patients (459/2354 [19.5%]; p < 0.01 for AF(+)/CCS(−) vs. AF(−)/CCS(+)).
Both AF (all-cause HR = 1.48, 95%CI, 1.09–2.01; cardiovascular HR = 1.34, 95%CI, 1.07–1.68) and obstructive CCS (all-cause HR = 1.90, 95%CI, 1.56–2.31; cardiovascular HR = 2.27, 95%CI, 1.94–2.65) were independent predictors of long-term mortality.
Cardiovascular mortality was higher in the AF(+)/CCS(+) subgroup (70.1%, N = 136) than in AF(−)/CCS(+) patients (53.2%, N = 244; p < 0.001).

Study Design

Type

Cohort (n=7,367)

Multicenter

No

Structured PICO

Does the presence of atrial fibrillation and/or obstructive chronic coronary syndrome increase long-term all-cause and cardiovascular mortality in patients referred for elective coronary angiography?

P

Population

7,367 consecutive patients referred for elective coronary angiography (median age 65, 46% female), excluding those with ACS or prior valve surgery, followed for a median of 2,029 days.

E

Exposure

Diagnosis of atrial fibrillation (AF) and/or obstructive chronic coronary syndrome (CCS, defined as ≥50% stenosis of the left main coronary artery or ≥70% stenosis of other coronary arteries)

C

Comparator

Patients stratified across four exposure subgroups: AF(+)/CCS(+), AF(+)/CCS(−), AF(−)/CCS(+), and AF(−)/CCS(−)

O

Outcome

Long-term all-cause mortality and cardiovascular mortality (ICD-10 codes I00 to I99) over a median follow-up of 2,029 (IQR 1,283–3,059) dayshard clinical

Main Result

Hazard Ratio: 1.48 (95% CI 1.09–2.01)

Among patients undergoing elective coronary angiography, both atrial fibrillation and obstructive chronic coronary syndrome independently predict long-term all-cause and cardiovascular mortality, and patients with AF without obstructive CCS have mortality at least as high as non-AF patients with obstructive CCS.

Limitations

Follow-up includes only mortality, with no data on nonfatal clinical events or patient health status
Retrospective single-center study design
Restricted to elective patients (acute coronary syndrome patients were excluded)
Fractional flow reserve measurements were not performed on a regular basis
Lack of reliable data on AF ablation procedures, smoking status, and diabetes therapy
High count of garbage codes in total mortality in Poland likely underestimates case-specific mortality
Follow-up includes only mortality with no data on nonfatal clinical events
Observations restricted to elective patients (ACS excluded)

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Implication

AF and obstructive chronic coronary syndrome were associated with higher mortality; leaves open whether they refine risk stratification in elective angiography patients.

Abstract

Over the next decades, the prevalence of atrial fibrillation (AF) is estimated to double. Our aim was to investigate the causes of the long-term mortality in relation to the diagnosis of atrial fibrillation (AF) and chronic coronary syndrome (CCS). The analysed population consisted of 7367 consecutive patients referred for elective coronary angiography enrolled in a large single-centre retrospective registry, out of whom 1484 had AF and 2881 were diagnosed with obstructive CCS. During follow-up (median = 2029 days), 1201 patients died. The highest all-cause death was seen in AF(+)/CCS(+) [194/527; 36.8%], followed by AF(+)/CCS(−) [210/957; 21.9%], AF(−)/CCS(+) [(459/2354; 19.5%)] subgroups. AF ([HR]AC = 1.48, 95%CI, 1.09–2.01; HRCV = 1.34, 95%CI, 1.07–1.68) and obstructive CCS (HRAC = 1.90, 95%CI, 1.56–2.31; HRCV = 2.27, 95%CI, 1.94–2.65) together with age, male gender, heart failure, obstructive pulmonary disease, diabetes were predictors of both all-cause and CV mortality. The main findings are as follow among patients referred for elective coronary angiography, both AF and obstructive CCS are strong and independent predictors of the long-term mortality. Mortality of AF without CCS was at least as high as non-AF patients with CCS. CV deaths were more frequent than non-CV deaths in AF patients with CCS compared to those with either AF or CCS alone.

Discussion

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Cite This Study

Kuźma et al. (2021) conducted a cohort in Suspected or confirmed obstructive chronic coronary syndrome and/or atrial fibrillation (n=7,367). Atrial fibrillation and/or obstructive chronic coronary syndrome vs. Patients without atrial fibrillation and/or without obstructive chronic coronary syndrome was evaluated on All-cause mortality associated with atrial fibrillation (HR 1.48, 95% CI 1.09-2.01). Atrial fibrillation and obstructive chronic coronary syndrome independently predicted long-term all-cause mortality in patients undergoing elective coronary angiography.

synapsesocial.com/papers/6a74bbb70081fe7b05dbe6d2 https://doi.org/10.3390/jcm10214949

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Predicting Mortality in Patients with Atrial Fibrillation and Obstructive Chronic Coronary Syndrome: The Bialystok Coronary Project

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Predicting Mortality in Patients with Atrial Fibrillation and Obstructive Chronic Coronary Syndrome: The Bialystok Coronary Project

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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