Incidence and outcome of atrial fibrillation in stable symptomatic coronary disease

Otterstad, Jan Erik; Lubsen, Jacobus; Brouwer, Sophie de; Fox, Keith A.A.; Corell, Pernille; Poole‐Wilson, Philip A.

doi:10.1080/14017430600746268

Cited by 34 publications

(31 citation statements)

References 25 publications

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“…In any event, in patients presenting with persistent signs of impaired LV dysfunction, coronary angiography and careful consideration about the underlying heart disease is recommended ([20] page 11). Ischemic cardiomyopathy, heart failure and neurohumoral activation are hypothesized to play an important mediating role in the development of new AF [5], [13] and previous studies have demonstrated the occurrence of AF in congestive heart failure and in myocardial infarction [26]. We agree with Movahed et al [22] that it is possible that coronary microvascular disease with ischemia (inducing metabolic stress) could be involved in the development of AF.…”

Section: Discussionsupporting

confidence: 81%

“…The Framingham study suggested that angina predisposed to AF and that the association of AF with CAD was stronger in men [7]. Despite the high prevalence of CAD in patients with AF of 18–46.5% [8]–[12], the prevalence of AF among patients with proven CAD is extremely low, at 0.2–5% [13]–[16]. By contrast, a survey of historic literature by Zipes indicates that AF commonly occurs in patients with CAD [17].…”

Section: Introductionmentioning

confidence: 99%

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Incidence and Severity of Coronary Artery Disease in Patients with Atrial Fibrillation Undergoing First-Time Coronary Angiography

et al. 2011

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BackgroundIn standard reference sources, the incidence of coronary artery disease (CAD) in patients with atrial fibrillation (AF) ranged between 24 and 46.5%. Since then, the incidence of cardiovascular risk factors (CRF) has increased and modern treatment strategies (“pill in the pocket”) are only applicable to patients without structural heart disease. The aim of this study was to investigate the incidence and severity of CAD in patients with AF.MethodsFrom January 2005 until December 2009, we included 261 consecutive patients admitted to hospital with paroxysmal, persistent or permanent AF in this prospective study. All patients underwent coronary angiography and the Framingham risk score (FRS) was calculated. Patients with previously diagnosed or previously excluded CAD were excluded.ResultsThe overall incidence of CAD in patients presenting with AF was 34%; in patients >70 years, the incidence of CAD was 41%. The incidence of patients undergoing a percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) was 21%. Patients with CAD were older (73±8 years vs 68±10 years, p = 0.001), had significantly more frequent hypercholesterolemia (60% vs 30%, p<0.001), were more frequent smokers (26% vs 13%, p = 0.017) and suffered from angina more often (37% vs 2%, p<0.001). There was a significant linear trend among the FRS categories in percentage and the prevalence of CAD and PCI/CABG (p<0.0001).ConclusionsThe overall incidence of CAD in patients presenting with AF was relatively high at 34%; the incidence of PCI/CABG was 21%. Based upon increasing CRF in the western world, we recommend a careful investigation respecting the FRS to either definitely exclude or establish an early diagnosis of CAD – which could contribute to an early and safe therapeutic strategy considering type Ic antiarrhythmics and oral anticoagulation.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Incidence and Severity of Coronary Artery Disease in Patients with Atrial Fibrillation Undergoing First-Time Coronary Angiography

et al. 2011

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“…The prevalence of AF in this unselected patient population undergoing PCI with the unrestricted use of DES amounted to 5.3%, which is consistent with previous reports of patients with stable CAD and acute MI [2][3][4][5][6][7] . In line with established risk factors for AF 8,9 , patients with AF were older and had a higher prevalence of hypertension and compromised left ventricular ejection fraction.…”

Section: Discussionsupporting

confidence: 78%

“…CAD and AF coexist in up to 25% of patients with stable CAD or acute myocardial infarction (MI) [2][3][4][5][6][7] , which may be related to common risk factors including advanced age, diabetes, hypertension, and congestive heart failure 8,9 . Apart from cerebrovascular events, AF has been associated with a one-and-a-half to twofold increased risk of mortality in the general population after adjustment for pre-existing cardiovascular conditions 8 as well as adverse in-hospital and long-term outcome after MI 4,10 .…”

mentioning

confidence: 99%

Impact of atrial fibrillation on clinical outcomes among patients with coronary artery disease undergoing revascularisation with drug-eluting stents

Pilgrim

Kalesan²,

Zanchin³

et al. 2013

EuroIntervention

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Aims: Coronary artery disease (CAD) and atrial fibrillation (AF) are major determinants of morbidity and mortality. A combined treatment with antiplatelet agents and vitamin K antagonists limits the risk of stent thrombosis and stroke while increasing the rate of bleeding. The objective of this study was to investigate the impact of atrial fibrillation (AF) on long-term clinical outcomes in patients with CAD undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES).Methods and results: Among 6,308 consecutive patients undergoing PCI with DES between 2002 and 2009, 323 (5.3%) patients were diagnosed with AF. We compared clinical outcomes between patients with and those without AF throughout four years. The primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), ischaemic stroke, and BARC bleeding type 3b/3c/5a/5b. In adjusted analyses, the primary composite endpoint was more frequent among patients with AF (HR 1.59, 95% CI 1.26-2.00; p<0.001). Differences were driven by an increased risk of all-cause mortality (HR 1.67, 95% CI 1.27-2.20; p=0.003), ischaemic stroke (HR 3.09, 95% CI 1.45-6.56; p=0.003), and intracranial bleeding (HR 4.28, p=0.013). We observed a gradient of risk among patients with higher CHA 2 DS 2 -VASc scores and modified outpatient bleeding risk index.Conclusions: Among patients with CAD undergoing revascularisation with DES, AF confers an increased risk of all-cause mortality, ischaemic stroke, and intracranial bleeding. The hazard imposed by AF correlates with the CHA 2 DS 2 -VASc score.

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“…В исследовании, выполненном S. Kralev et al, у 13% пациентов с ФП, подвергшихся коронаро-графии, диагностированы гемодинамически значимые стенозы коронарных артерий, а час-тота постоянной формы аритмии была практи-чески идентичной в обеих группах -с ИБС и без нее (30 и 27% соответственно) [11]. В свою оче-редь, частота сопутствующей ФП среди больных ИБС составляет всего лишь в 0,2-5% [12].…”

Section: Introductionunclassified

Aspects of antithrombotic therapy in patients with atrial fibrillation and coronary disease

Bockeria¹,

Gafurov²

2018

Ann aritmol

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Incidence and outcome of atrial fibrillation in stable symptomatic coronary disease

Abstract: The presence of AF in patients with stable symptomatic CAD is an independent risk factor and in particular in the first 30 days for subsequent mortality and morbidity.

Cited by 34 publications

References 25 publications

Incidence and Severity of Coronary Artery Disease in Patients with Atrial Fibrillation Undergoing First-Time Coronary Angiography

Incidence and Severity of Coronary Artery Disease in Patients with Atrial Fibrillation Undergoing First-Time Coronary Angiography

Impact of atrial fibrillation on clinical outcomes among patients with coronary artery disease undergoing revascularisation with drug-eluting stents

Aspects of antithrombotic therapy in patients with atrial fibrillation and coronary disease

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