Comparison of prognosis and outcomes of catheter ablation versus drug therapy in patients with atrial fibrillation and stable coronary artery disease: A prospectivepropensity‐scorematched cohort study

Yi‐Kai Cui; Jianzeng Dong; Xin Du; Rong Hu; Liu He; Chang‐Qi Jia; Xu Li; Jiahui Wu; Ronghui Yu; Deyong Long; Man Ning; Caihua Sang; Chenxi Jiang; Rong Bai; Songnan Wen; Nian Liu; Songnan Li; Wei Wang; Xueyuan Guo; Xin Zhao; Xuan Chen; Shu‐Tao Huang; Hao‐Sheng Wu; Ribo Tang; Changsheng Ma

doi:10.1002/clc.23699

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Why the study?

AF and SCAD frequently coexist, prompting investigation into the prognosis of catheter ablation versus drug therapy in this population.

Does catheter ablation improve outcomes in patients with atrial fibrillation and stable coronary artery disease compared to drug therapy?

Structured PICO

Does catheter ablation improve outcomes in patients with atrial fibrillation and stable coronary artery disease compared to drug therapy?

P

Population

1,630 patients with atrial fibrillation (AF) and stable coronary artery disease (SCAD) from the Chinese AF Registry (815 matched 1:1).

I

Intervention

Catheter ablation therapy

C

Comparator

Drug therapy

O

Outcome

Composite of thromboembolism, coronary events, major bleeding, and all-cause deathcomposite

Implication

Catheter ablation in patients with concurrent AF and stable CAD may offer a mortality benefit over drug therapy alone, despite not significantly reducing a broad composite of adverse events.

Abstract

BACKGROUND: Atrial fibrillation (AF) and stable coronary artery disease (SCAD) frequently coexist. HYPOTHESIS: To investigate the prognosis of catheter ablation versus drug therapy in patients with AF and SCAD. METHODS: In total, 25 512 patients with AF in the Chinese AF Registry between 2011 and 2019 were screened for SCAD. 815 patients with AF and SCAD underwent catheter ablation therapy were matched with patients by drug therapy in a 1:1 ratio. Primary end point was composite of thromboembolism, coronary events, major bleeding, and all-cause death. The secondary endpoints were each component of the primary endpoint and AF recurrence. RESULTS: Over a median follow-up of 45 ± 23 months, the patients in the catheter ablation group had a higher AF recurrence-free rate (53.50% vs. 18.41%, p < .01). In multivariate analysis, there was no significant difference between the strategy of catheter ablation and drug therapy in primary composite end point (adjusted HR 074, 95%CI 0.54-1.002, p = .0519). However, catheter ablation was associated with fewer all-cause death independently (adjusted HR 0.36, 95%CI 0.22-0.59, p < .01). In subgroup analysis, catheter ablation was an independent risk factor for all-cause death in the high-stroke risk group (adjusted HR 0.39, 95%CI 0.23-0.64, p < .01), not in the low-medium risk group (adjusted HR 0.17, 95%CI 0.01-2.04, p = .17). CONCLUSIONS: In the patients with AF and SCAD, catheter ablation was not independently associated with the primary composite endpoint compared with drug therapy. However, catheter ablation was an independent protective factor of all-cause death.