Clinical profile and angiographic findings among patients with atrial fibrillation presenting for selective coronary angiography

Abstract

Background: Coronary artery disease is the most common form of cardiovascular disease while Atrial fibrillation is the most common sustained arrhythmia. We set out to investigate the prevalence and clinical profile of patients with atrial fibrillation who present for selective coronary angiography and whether this has an effect on the angiogram findings and the treatment options offered to them. Methods and Results: This was a retrospectively collected database of 494 patients presenting for SCAG from 01.11.2010 to 30.11.2010 and 01.04.2010 to 30.04.2010. We collected and analyzed clinical characteristics of patients, their SCAG finding and modes of treatment offered up to discharge. 24.6% of patients had AF. They tended to be older, more commonly women, current or ex-smokers; presented with symptoms of atypical chest pain and were more likely to have a history of congestive heart failure or valvular heart disease. They had a longer hospital stay. Using CHADS-Vasc score, 83.6% were moderate to high risk for CVA. At SCAG, they were more likely to have non-significant coronary artery disease, and hence were more likely to be treated conservatively. Conclusion: AF patients presenting for SCAG constitute a unique subset of patients who despite having a higher likelihood of non-significant coronary stenosis are still prone to suffering from poorly-understood and under-appreciated myo-cardial ischemia.

The antithrombotic therapy of atrial fibrillation in patients with coronary heart disease

“…In one study, the author found the release of troponin in 15% of patients with AF and symptoms of myocardial ischemia, with normal angiography data [26]. In a retrospective analysis of the database of patients who underwent coronary angiography, the presence of AF at the time of the procedure or in history was a factor associated with initial coronary heart disease [27]. Thus, patients with isolated AF and the absence of risk factors for coronary heart disease should be searched for the causes of arrhythmia.…”

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

“…В одном из исследований автором обнаружено высво-бождение тропонина у 15% пациентов с ФП и симптомами ишемии миокарда при нормаль-ных данных ангиографии [26]. В ретроспектив-ном анализе базы данных больных, которым проведена коронарография, наличие ФП на мо-мент процедуры или в анамнезе было фактором, связанным с начальной коронарной болезнью сердца [27]. Таким образом, при лечении паци-ентов с изолированной ФП и отсутствием фак-торов риска ИБС следует искать причины раз-вития аритмии.…”

The incidence of atrial fibrillation in patients with coronary artery disease

“…Slično našim nalazima su rezultati studije kojom su obuhvaćene osobe poslate na selektivnu koronarogra- fiju koji pokazuju učestalost AF koja se kretala od niske 2,3% do znatne 24,6% s tim da je većina ispitanika imala neznačajnu bolest koronarnih arterija 10,23 . Zielonka i saradnici 24 kod bolesnika sa stabilnom koronarnom bolešću, nalaze da je AF prisutna kod 19%, što je dva puta veća učestalost od naših nalaza ali u starijoj populaciji.…”

“…Moguće je da bolesnici sa AF imaju ishemiju miokarda ali ne samo zbog koronarne stenoze već i zbog naglašenog simpatičkog tonusa koji uzrokuje pojačanu vazokonstrikciju 10,27 . Osim toga, dokazano je da postoje i uticaji srčane ishemije indukovane bolestima malih koronarnih arterija nezavisno od koronarnih stenoza velikih sudova 20 .…”

“…To je pokazano i u drugim studijama u kojima bolesnici sa AF i koronarnom bolešću imaju češće hroničnu srčanu insuficijenciju, bolest mitralnih zalistaka uzrokovanih uglavnom ishemijskom bolešću srca ili dilatacijom mitralnog prstena zbog ishemijske srčane insuficijencije 1,10,20,31 .…”