Key result
Opportunistic screening with coronary artery calcium score during cardiac CT for atrial fibrillation ablation revealed CACS >0 in 54% of patients, identifying 25% as candidates for statin therapy.
Why the study?
Coronary artery calcium score refines CV risk stratification, but the impact of opportunistic CACS screening on risk stratification and preventive therapy decisions in patients with AF remains to be evaluated.
Does opportunistic CACS screening during pre-ablation cardiac CT alter preventive therapy recommendations in patients with atrial fibrillation?
Cross-Sectional (n=474)
Does opportunistic CACS screening during pre-ablation cardiac CT alter preventive therapy recommendations in patients with atrial fibrillation?
Opportunistic CACS evaluation during pre-ablation cardiac CT in AF patients frequently identifies coronary calcium, potentially altering primary cardiovascular prevention strategies in a significant proportion of patients.
Opportunistic CACS during AF ablation may identify candidates for statin initiation or intensification; leaves open whether routine use improves outcomes.
INTRODUCTION: There is a well-established association between atrial fibrillation (AF) and coronary artery disease. Coronary artery calcium score (CACS) is a helpful tool to refine cardiovascular (CV) risk stratification and inform on the best strategies for primary CV prevention. This study aims to evaluate the impact of opportunistic screening with CACS on risk stratification and decision of preventive therapies, in patients with AF. METHODS: Cross-sectional study including patients with AF or atrial flutter undergoing cardiac computed tomography for ablation procedure planning, from 2017 to 2019. Baseline clinical and demographical data were collected. CACS was assessed in patients without coronary artery disease using the Agatston method. RESULTS: A total of 474 patients were included (93% with AF, mean age of 58 ± 10 years, 62% male). CACS >0 was present in 254 (54%) patients. According to CACS and the Society of Cardiovascular Computed Tomography recommendations, 25% of the patients would be candidates for statin therapy and 17% would be candidates for changes in the current statin intensity; in 11 patients (8%), acetylsalicylic acid would be recommended. CONCLUSION: In our study, more than half of the patients undergoing cardiac computed tomography before AF catheter ablation had CACS above zero. Our findings suggest that an opportunistic evaluation of CACS at the time of ablation can be an important tool to improve CV risk stratification, with important clinical and therapeutic implications.
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Fernandes et al. (2023) conducted a cross-sectional in Atrial fibrillation or atrial flutter (n=474). Opportunistic screening with coronary artery calcium score (CACS) was evaluated on Presence of CACS >0. Opportunistic screening with coronary artery calcium score during cardiac CT for atrial fibrillation ablation revealed CACS >0 in 54% of patients, identifying 25% as candidates for statin therapy.
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