Key result
AF linked to more obstructive CAD but fails to increase abnormal stress tests.
Why the study?
The relationship between the higher burden of CAD in AF patients and the burden of myocardial ischemia was unknown.
Does the presence of atrial fibrillation correlate with a higher burden of obstructive coronary artery disease and myocardial ischemia compared to patients without atrial fibrillation?
Case-Control (n=209)
Yes
Does the presence of atrial fibrillation correlate with a higher burden of obstructive coronary artery disease and myocardial ischemia compared to patients without atrial fibrillation?
Absolute Event Rate: 39% vs 31%
p-value: p=0.23
Although patients with atrial fibrillation have a higher burden of obstructive coronary artery disease, this does not translate into a higher burden of myocardial ischemia on stress testing.
AF patients have higher obstructive CAD prevalence without increased positive stress tests; leaves open ischemia-guided management strategies in observational cohorts.
Atrial fibrillation (AF) has been linked to the presence of underlying coronary artery disease (CAD). However, whether the higher burden of CAD observed in AF patients translates into higher burden of myocardial ischemia is unknown. In 87 patients (71% male, mean age 61 ± 10 years) with paroxysmal or persistent AF and without history of CAD, MSCT coronary angiography and stress testing (exercise ECG test or myocardial perfusion imaging) were performed. CAD was classified as obstructive (≥50% luminal narrowing) or not. Stress tests were classified as normal or abnormal. A population of 122 patients without history of AF, similar to the AF group as to age, gender, symptomatic status and pre-test likelihood, served as a control group. Based on MSCT, 17% of AF patients were classified as having no CAD, whereas 43% showed non-obstructive CAD and the remaining 40% had obstructive CAD. A positive stress test was observed in 49% of AF patients with obstructive CAD. Among non-AF patients, 34% were classified as having no CAD, while 41% showed non-obstructive CAD and 25% had obstructive CAD (P = 0.013 compared to AF patients). A positive stress test was observed in 48% of non-AF patients with obstructive CAD. In conclusion, the higher burden of CAD observed in AF patients is not associated to higher burden of myocardial ischemia.
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Nucifora et al. (2010) conducted a case-control in Paroxysmal or persistent atrial fibrillation (n=209). Atrial fibrillation vs. No history of atrial fibrillation was evaluated on Abnormal stress test (p=0.23). Patients with atrial fibrillation had a higher prevalence of obstructive coronary artery disease than controls (40% vs 25%), but this did not translate to a significantly higher rate of abnormal stress tests (39% vs 31%).
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