Why the study?
Determining whether chest pain during an episode of atrial fibrillation is caused by coronary artery disease or the arrhythmia itself poses a clinical challenge.
Do clinical, imaging, or laboratory markers predict significant CAD in patients admitted with atrial fibrillation and chest pain?
Do clinical, imaging, or laboratory markers predict significant CAD in patients admitted with atrial fibrillation and chest pain?
In patients presenting with atrial fibrillation and chest pain, elevated troponin and regional wall motion abnormalities are highly predictive of obstructive CAD, whereas clinical symptoms and ECG changes are not.
Typical symptoms or ECG changes should not yet rule out CAD work-up; leaves open confirmation of troponin and RWMA as predictors in larger cohorts.
INTRODUCTION: Patients who present to the emergency department with chest pain during an episode of atrial fibrillation (AF) impose a clinical challenge regarding the source of pain - being coronary artery disease (CAD) or AF in origin. The aim of this study was to identify clinical, imaging or laboratory markers which can predict significant CAD among patients with an AF episode and chest pain. METHODS: We included 57 consecutive patients admitted to our hospital with AF and chest pain. All patients underwent coronary evaluation. Significant CAD was defined as >50% stenosis in a major coronary artery by coronary angiography or cardiac CT. We compared CAD and non-CAD groups and analyzed risk factorsby regression analysis. RESULTS: Twenty-four patients (42%) were diagnosed with- and 33 patients (58%) without obstructive CAD. In a multivariate analysis of regional wall motion abnormality (RWMA), elevated troponin and hypertension were found to be predictors for CAD [odds ratio (OR), 22.4 (confidence interval (CI), 1.8-272.4; P = 0.02); OR, 5.6 (CI, 1-31.0; P = 0.05) and OR, 21.4 (CI, 1.6-284.6; P = 0.02), respectively]. There were no significant differences regarding the rate of typical chest pain at presentation in the CAD vs. the non-CAD group [13 (54%) vs. 20 (60%), P = 0.374], or in ECG ST-changes [12 (50%) vs.9 (27%), respectively; P = 0.08]. CONCLUSION: In patients who present acutely with chest pain and AF, troponin elevation and RWMA appear to be highly predictive of obstructive CAD, whereas clinical symptoms and ECG changes are not predictive. These findings may be helpful for guiding the management of patients admitted with AF and chest pain.
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Brezinov et al. (2022) studied this question.
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