Key result
Coronary angiography reveals atherosclerotic CAD in ~70% of patients with persistent non-valvular AF.
Why the study?
The relationship between persistent non-valvular atrial fibrillation and coronary artery disease is well established but often missed, with evidence of myocardial ischemia in AF patients without obstructive CAD.
Cohort (n=70)
No
A high proportion (70%) of patients with persistent non-valvular AF without known CAD have angiographic evidence of CAD, and slow coronary flow is associated with increased hospitalizations for fast ventricular rates.
BACKGROUND: The relationship of atrial fibrillation (AF) with coronary artery disease (CAD) is well established, yet it is often missed. There is evidence of myocardial ischemia on stress imaging in AF patients in the absence of obstructive CAD. In this prospective cohort, we studied the angiographic profiles of non-valvular AF patients. METHODS: The study was a nonrandomized, prospective, single-center observational study of consecutive patients of persistent non-valvular AF. Patients symptomatic for AF despite optimal medical therapy for 3 months were recruited and all underwent coronary angiograms (CAG). Patients with prior history of CAD were excluded. RESULTS: A total of 70 patients were followed for a mean duration of 12 ± 1.4 months. The mean age of the study group was 66.07 (±11.49) years. Hypertension was the commonest comorbidity seen in 74% patients. Obstructive CAD was present in 32 (46%) patients, non-obstructive (<50% stenosis) CAD in 17 (24%) patients and normal coronaries in 21 (30%) patients. Overall 49 (70%) patients had evidence of CAD. Amongst patients without obstructive CAD, slow flow was seen in 16 (42%) patients. Lower baseline ejection fraction, lower haemoglobin & albumin levels and higher creatinine levels was associated with increased mortality. In patients without obstructive CAD, hospitalizations for fast ventricular rate were significantly increased in those having slow flow on CAG (p = 0.005). CONCLUSIONS: Majority (70%) of our patients had evidence of atherosclerotic CAD on CAG. A large proportion of patients without obstructive CAD had slow flow on CAG.
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Sharma et al. (2021) conducted a cohort in Persistent non-valvular atrial fibrillation (n=70). Persistent non-valvular atrial fibrillation was evaluated on Evidence of coronary artery disease on coronary angiogram. Among patients with persistent non-valvular atrial fibrillation, 70% had evidence of atherosclerotic coronary artery disease on coronary angiography.
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