Department of Cardiology, Medical University of Bialystok, Białystok, Poland.
Department of Cardiology and Internal Medicine, Medical University of Gdansk, Gdynia, Poland
Pol Arch Intern Med. 2020 Dec 22;130(12):1029-1036. doi: 10.20452/pamw.15635. Epub 2020 Oct 5.
Atrial fibrillation (AF) and chronic coronary syndrome (CCS) share common risk factors and frequently coexist. Additionally, AF symptoms may mimic CCS.
The aim of the study was to investigate the hypothesis indicating absence of significant coronary lesions in patients with AF as compared with those with sinus rhythm.
We conducted a single‑center retrospective study including consecutive patients referred for elective coronary angiography between 2007 and 2016.
The study population included 8288 patients out of whom 1674 had AF. There were substantial differences between groups with and without AF. Patients with AF were significantly older, more often were men and had diabetes, and more frequently were diagnosed with both chronic kidney disease and heart failure. On the other hand, they had history of hyperlipidemia less often. CCS was less frequently detected in patients with AF as compared with those with sinus rhythm (37.5% vs 41.1%; P <0.001). Additionally, the latter group more often underwent subsequent coronary angioplasty (19.2% vs 22.3%; P = 0.004). Multivariable analysis identified AF as an independent factor associated with absence of significant coronary lesions (odds ratio, 1.57; 95% CI, 1.32-1.87; P <0.001). Moreover, a comparison between patients with and without angiographically significant CCS revealed a higher prevalence of AF in the latter group (18.7% vs 21.2%; P = 0.006).
In our study, AF was associated with the absence of significant coronary lesions on angiography, reflecting difficulties with qualifying patients with AF for invasive CCS diagnostic workup. Our findings suggest the need for more efficacious noninvasive diagnostic approach for patients with AF and suspected CCS.
心房颤动（AF）和慢性冠状动脉综合征（CCS）有共同的危险因素，且常同时存在。此外，AF 的症状可能与 CCS 相似。
本研究旨在验证这样一个假设，即在 AF 患者中，与窦性心律患者相比，其不存在显著的冠状动脉病变。
我们进行了一项单中心回顾性研究，纳入了 2007 年至 2016 年间因选择性冠状动脉造影而转诊的连续患者。
研究人群包括 8288 例患者，其中 1674 例患有 AF。有 AF 组和无 AF 组之间存在显著差异。AF 患者年龄明显更大，更多为男性，患有糖尿病，且同时患有慢性肾脏病和心力衰竭的比例更高。另一方面，他们患有高脂血症的比例较低。与窦性心律患者相比，AF 患者 CCS 的检出率较低（37.5% vs 41.1%；P <0.001）。此外，后者组更常进行随后的冠状动脉成形术（19.2% vs 22.3%；P = 0.004）。多变量分析确定 AF 是与无显著冠状动脉病变相关的独立因素（比值比，1.57；95%置信区间，1.32-1.87；P <0.001）。此外，在有和无血管造影意义上的 CCS 的患者之间进行比较，发现后者组的 AF 发生率更高（18.7% vs 21.2%；P = 0.006）。
在我们的研究中，AF 与冠状动脉造影无显著病变相关，这反映了在 AF 患者中，进行有创性 CCS 诊断性检查的困难。我们的研究结果表明，对于疑似 CCS 的 AF 患者，需要更有效的非侵入性诊断方法。
