Medical treatment and long-term outcome of chronic atrial fibrillation in the aged with chest distress: a retrospective analysis versus sinus rhythm

Abstract

Although “chest distress” is the most frequent complication in the aged with chronic atrial frbrillation (AF) in clinical practice, there are few data on the association between chronic AF and coronary artery disease (CAD) in the aged in terms of medical treatment and long-term outcome. We assessed coronary artery lesions in such patients and evaluated the efficacy of medical treatment in long-term follow-ups. Of 315 elderly patients (mean age: 77.39 ± 6.33 years) who had undergone coronary angiography for chest distress, 297 exhibited sinus rhythm (SR), whereas 18 patients exhibited chronic AF. Patients with AF were followed for 4.22 ± 2.21 years. Average diastolic blood pressure (DBP) of AF patients was observed to be markedly less than that of patients with SR (57.33 ± 6.87 mmHg vs 71.08 ± 10.54 mmHg, t-test: P < 0.01). Compared with SR patients, severe stenosis of the coronary artery in AF patients was reduced (73.06% vs 44.44%, Chi-square test: P < 0.01). AF patients with chest distress had high CHADS2 score (3.72 ± 1.27), but only 33.3% patients received oral anticoagulants, and such patients had a significantly lower rate of revascularization (21.43% vs 55.63%, Chi-square test: P < 0.01), and higher rate of all-cause death (22.22% vs 4.38%, Chi-square test: P < 0.01) and thromboembolism (16.67% vs 1.68%, Chi-square test: P < 0.01) in the long-term follow-ups compared with SR patients. Chest distress in the aged with AF was related to insufficient coronary blood supply that was primarily due to a reduced DBP rather than to occult CAD. Adequate and safe medical therapy was difficult to achieve in these patients. Such patients typically have a poor prognosis, and optimal therapeutic strategies to treat them are urgently needed.

Coronary artery disease among patients admitted with atrial fibrillation and chest pain

“…Although chest pain characteristics are much more specific in evaluating patients with the chronic coronary syndrome, acute tachycardia symptoms might mimic typical angina and can be defined as disabling in up to 86% [9]. Similar to our results, a study by Guo et al that focused on the elderly population (mean age 77.4 ± 6.3 years) showed that chest distress experienced by patients with AF was not related to the prevalence of significant CAD [10]. In our study chest pain type was not associated with the prevalence of significant CAD as well.…”

“…Similar to our results, a study by Guo et al . that focused on the elderly population (mean age 77.4 ± 6.3 years) showed that chest distress experienced by patients with AF was not related to the prevalence of significant CAD [10]. In our study chest pain type was not associated with the prevalence of significant CAD as well.…”