Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2011;6(9):e24964.
doi: 10.1371/journal.pone.0024964. Epub 2011 Sep 21.

Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography

Stefan Kralev  1 , Kathrin Schneider, Siegfried Lang, Tim Süselbeck, Martin Borggrefe
Affiliations
Clinical Trial

Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography

Stefan Kralev et al. PLoS One. 2011.

Abstract

Background: In 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.

Methods: From 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.

Results: The 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).

Conclusions: The 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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Significant linear trend among the FRS categories in % and the prevalence of CAD and PCI/CABG (p<0.0001).
CABG = Coronary Artery Bypass Graft, CAD = Coronary Artery Disease, FRS = Framingham Risk Score, PCI = Percutaneous Coronary Intervention.
Figure 2
Figure 2. Incidence and severity of coronary artery disease in patients presenting with atrial fibrillation according to age.
CAD = Coronary Artery Disease, PCI = Percutaneous Coronary Intervention.
Figure 3
Figure 3. Overview of reported incidences of coronary artery disease in patients presenting with atrial fibrillation.
AF = Atrial Fibrillation, CAD = Coronary Artery Disease, PCI = Percutaneous Coronary Intervention.
Figure 4
Figure 4. Prevalence and management of coronary artery disease (drug-treated stable CAD vs. PCI/CABG) according to subtype of atrial fibrillation did not differ significantly.
AF = Atrial Fibrillation, CABG = Coronary Artery Bypass Graft, CAD = Coronary Artery Disease, PCI = Percutaneous Coronary Intervention.
Figure 5
Figure 5. Unsuccessful but also successful electrical cardioversion were more frequently performed in patients without CAD than in patients with stable CAD or with PCI/CABG (p<0.01).
CAD = Coronary Artery Disease, CABG = Coronary Artery Bypass Graft, CV = electrical Cardioversion, PCI = Percutaneous Coronary Intervention.
See this image and copyright information in PMC

References

    1. Go AS, Hylek EM, Philips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (ATRIA) Study. JAMA. 2001;285:2370–5. - PubMed
    1. Paquette M, Roy D, Talajic M, Newman D, Couturier A, et al. Role of gender and personality on quality-of-life impairment in intermittent atrial fibrillation. Am J Cardiol. 2000;86(7):764–8. - PubMed
    1. Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med. 1982;306(17):1018–22. - PubMed
    1. Pizzenetti F, Turazza FM, Franzosi MG, Barlera S, Ledda A, et al. GISSI-3 Investigators. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data. Heart. 2001;86(5):527–532. - PMC - PubMed
    1. Gersh BJ, Tsang TSM, Barnes ME, Seward JB. The changing epidemiology of non-valvular atrial fibrillation: The role of novel risk factors. Eur Heart J Supplements. 2005;7(Suppl C):C5–C11.

Publication types