Prevalence of Coronary Artery Calcification on Pre-Atrial Fibrillation Ablation CT Pulmonary Venograms and its Impact on Selection for Statin Therapy

Abstract

Atherosclerotic cardiovascular disease (ASCVD) shares many risk factors with atrial fibrillation (AF). Obtaining computed tomography images of the pulmonary veins (CTPV) before AF ablation procedures is common and can incidentally detect coronary artery calcification (CAC). The purpose of this study was to investigate the prevalence of CAC on pre-ablation CTPV, the frequency of CAC reporting on CTPV reports, and its impact on statin therapy among patients hospitalized for AF procedures. We retrospectively evaluated consecutive patients undergoing CTPV and AF procedures from October 2016 to December 2017 in a single-center tertiary hospital. The patients’ demographic and clinical characteristics were analyzed. The CAC presence on CTPV was visually assessed. The severity was classified qualitatively. The statin therapy status was evaluated using the patient’s admission and discharge medication lists. A total of 638 subjects were included in our study, with 34.5% female. The mean age was 63.3 ± 10.8 years. CAC was detected in 70.1% of all patients, and in 58.1% of patients without a history of ASCVD. When present, CAC was documented in 92.6% of the clinical CTPV reports. While coronary artery atherosclerosis was present in a majority of AF patients, and its presence was widely reported, it was not associated with increased statin therapy at discharge.

Impact of Coronary Artery Calcium Score Screening on Cardiovascular Risk Stratification of Patients with Atrial Fibrillation Undergoing Ablation

“…Several studies have shown a high prevalence of coronary artery calcium (58-74%) in patients with AF who underwent CCT before pulmonary vein isolation for procedural planning [9,10,[14][15][16]. Chaikriangkrai et al [9] demonstrated that patients with AF had a higher prevalence of coronary artery calcium when compared to controls with normal sinus rhythm presenting with chest pain (74% vs. 63%, p < 0.001), despite similar CV risk scores.…”

High incidence of newly diagnosed obstructive coronary artery disease regardless of chest pain detected on pre-procedural cardiac computed tomography angiography in patients undergoing atrial fibrillation ablation

“…Additional coronary evaluation is not a required protocol during pre-ablation cardiac CTA but CACS is an often available parameter on pre-ablation scans focusing on pulmonary vein morphology. CAC was visually detected at a very high, 70.1% among the 638 patients with atrial fibrillation in Dunleavy et al .’s publication [ 12 ]. Visual CACS estimation was also used in the study of Hillerson et al ., where 59.6–63.5% CAC was found on 278 non-gated CT scans retrospectively [ 19 ].…”

“…Multiple studies have shown that at least 10%, or in some publications even 70% of patients with atrial fibrillation have CAD [11][12][13][14]. Most of these referred publications used different definitions to determine the presence of CAD with lower spatial resolution CT scans assessing only a few hundred patients [8,[11][12][13][14].…”