Health> Vol.6 No.1, January 2014

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

DownloadDownload as PDF (Size:353KB)  HTML    PP. 44-50  

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 myocardial ischemia.

Cite this paper

Elabbassi, W. , Chowdhury, M. , Liska, B. and Hatala, R. (2014) Clinical profile and angiographic findings among patients with atrial fibrillation presenting for selective coronary angiography. Health, 6, 44-50. doi: 10.4236/health.2014.61007.

References

[1] European Cardiovascular Disease Statistics (2005) British Heart Foundation Health Promotion Research Group.
[2] (2009) Heart disease and stroke statistics—2010 update. Circulation, 121, e46-e215.
[3] Steg, G. (on behalf of the BEAUTIFUL Executive Committee) (2009) The CLARIFY registry: Management of stable coronary artery disease in clinical practice. Brochure for participating doctors.
[4] (2010) Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal, 31, 2501-2555.
[5] ACCF/SCAI/STS/AATS/AHA/ASNC (2009) Appropriateness criteria for coronary revascularization. Journal of the American College of Cardiology, 530-553.
[6] Go, A.S., Hylek, E.M., Philips, K.A., Chang, Y.C., Henault, L.E., Selby, J.V. and Singer, D.E. (2001) Prevalence of diagnosed atrial fibrillation in adults: Nationalimplications for rhythm management and stroke prevention: The anticoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA, 285, 2370-2375.
http://dx.doi.org/10.1001/jama.285.18.2370
[7] European Heart Rhythm Association, European Association for for Cardio-Thoracic Surgery, Camm, A.J., Kirchhof, P., Lip, G.Y.H., Schotten, U., Savelieva, I., Ernst, S., Van Gelder, I.C., Al-Attar, N., Hindricks, G., Prendergast, B., Heidbuchel, H., Alfieri, O., Angelini, A., Atar, D., Colonna, P., De Caterina, R., De Sutter, J., Goette, A., Gorenek, B., Heldal, M., Hohloser, S.H., Kolh, P., Le Heuzey, J.Y., Ponikowski, P. and Rutten, F.H. (2010) Guidelines for the management of atrialfibrillation: The task force for the management of atrial fibrillation. European Heart Journal, 31, 2369-2429.
http://dx.doi.org/10.1093/eurheartj/ehq278
[8] Lloyd-Jones, D.M., Wang, T.J., Leip, E.P., Larson, M.G., Levy, D., Vasan, R.S., D’Agostino, R.B., Massaro, J.M., Beiser, A., Wolf, P.A. and Benjamin, E.J. (2004) Lifetime risk for development of atrial fibrillation: The framingham heart study. Circulation, 110, 1042-1046.
http://dx.doi.org/10.1161/01.CIR.0000140263.20897.42
[9] Wattigney, W.A., Mensah, G.A. and Croft, J.B. (2003) Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: Implications for primary prevention. Circulation, 108, 711-716.
http://dx.doi.org/10.1161/01.CIR.0000083722.42033.0A
[10] Stewart, S., Hart, C.L., Hole, D.J. and McMurray, J.J. (2002) A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. American Journal of Medicine, 113, 359-364.
http://dx.doi.org/10.1016/S0002-9343(02)01236-6
[11] Lévy, S. (1998) Epidemiology and classification of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 9, S78-S82.
[12] Quirino, G., Giammaria, M., Corbucci, G., Pistelli, P., Turri, E., Mazza, A., Perucca, A., Checchinato, C., Dalmasso, M. and Barold, S.S. (2009) Diagnosis of paroxysmal atrial fibrillation in patients with implanted pacemakers: Relationship to symptoms and other variables. Pacing and Clinical Electrophysiology, 32, 91-98.
http://dx.doi.org/10.1111/j.1540-8159.2009.02181.x
[13] Haigney, M.C. (2007) Reduced myocardial perfusion in atrial fibrillation: When the egg comes before the chicken. European Heart Journal, 28, 2181-2182.
http://dx.doi.org/10.1093/eurheartj/ehm330
[14] Cheng, T.O. (1974) Coronary artery disease as an uncommon cause of atrial fibrillation. Clinical Research, 22, 268A.
[15] Haddad, A.H., Prchkov, V.K. and Dean, D.C. (1978) Chronic atrial fibrillation and coronary artery disease. Journal of Electrocardiology, 11, 67-69.
http://dx.doi.org/10.1016/S0022-0736(78)80031-4
[16] Cameron, A., Schwartz, M.J., Kronmal, R.A. and Kosiuski, A.S. (1988) Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry). American Journal of Cardiology, 61, 714-717.
http://dx.doi.org/10.1016/0002-9149(88)91053-3
[17] Galrinho, A., Gomes, J.A., Antunes, E., Catarino, C., da Silva, N., Ferreira, R., Quininha, J. and Rato, J.A. (1993) Atrial fibrillation and coronary disease. Revista Portuguesa de Cardiologia, 12, 1037-1040.
[18] Shen, W., Feng, Y. and Gong, L. (1993) Atrial fibrillation and coronary artery disease. Chinese Medical Sciences Journal, 8, 177-179.
[19] Lokshyn, S., Mewis, C. and Kuhlkamp, V. (2000) Atrial fibrillation in coronary artery disease. International Journal of Cardiology, 72, 133-136.
http://dx.doi.org/10.1016/S0167-5273(99)00180-1
[20] Kanjwal, K., Imran, N., Grubb, B. and Kanjwal, Y. (2008) Troponin elevation in patients with various tachycardias and normal epicardial coronaries. Indian Pacing and Electrophysiology Journal, 8, 172-174.
[21] AFFIRM Investigators (2002) Baseline characteristics of patients with atrial fibrillation: The AFFIRM study. American Heart Journal, 143, 991-1001.
[22] Kralev, S., Schneider, K., Lang, S., Suselback, T. and Borggrefe, M. (2011) Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography. PLoS One, 6, e24964. http://dx.doi.org/10.1371/journal.pone.0024964
[23] Kannel, W.B., Wolf, P.A., Benjamin, E.J. and Levy, D. (1998) Prevalence, incidence, prognosis and predisposing conditions for atrial fibrillation: Population based estimates. American Journal of Cardiology, 82, 2N-9N.
http://dx.doi.org/10.1016/S0002-9149(98)00583-9
[24] Selzer, A. and Katayama, F. (1972) Mitral regurgitation— Clinical patterns, pathophysiology and natural history. Medicine, 51, 337-332.
[25] Ellis, L.B. and Ramirez, A. (1969) The clinical course of patients with severe rheumatic mitral insufficiency. American Heart Journal, 78, 406-418.
http://dx.doi.org/10.1016/0002-8703(69)90047-7
[26] Van den Berg, M.P., Tuinenburg, A.E., Crijns, H.J., Van Gelder, I.C., Gosselink, A.T. and Lie, K.I. (1997) Heart Failure and atrial fibrillation: Current concepts and controversies. Heart, 77, 309-313.
[27] Veloso, H.H. and Costa Diniz, M. (2000) Are physicians recommending coronary angiographies more than necessary in atrial fibrillation? International Journal of Cardiology, 76, 85-86.
http://dx.doi.org/10.1016/S0167-5273(00)00359-4
[28] Range, F.T., Schafers, M., Acil, T., Schafers, K.P., Kies, P., Paul, M., Hermann, S., Brisse, B., Breithardt, G., Schober, O. and Wichter, T. (2007) Impaired myocardial perfusion and perfusion reserve associated with increased coronary resistance in persistent idiopathic atrial fibrillation. European Heart Journal, 28, 2223-2230.
http://dx.doi.org/10.1093/eurheartj/ehm246
[29] Friedman, H.S., Scorza, J., McGuinn, R. and Shaughnessy, E. (1985) The effects of atrial fibrillation on myocardial blood flow and energetics. Experimental Biology and Medicine, 180, 1-8.
http://dx.doi.org/10.3181/00379727-180-42135
[30] Ertl, G., Wichmann, J., Kaufmann, M. and Kochsiek, K. (1986) Alpha-receptor constriction induced by atrial fibrillation during maximal coronary dilatation. Basic Research in Cardiology, 81, 29-39.
http://dx.doi.org/10.1007/BF01907425
[31] Kochiadakis, G., Skalidis, E., Kalebubas, M., Igoumenidis, N.E., Chrysostomakis, S.I., Kanoupakis, E.M., Simantirakis, E.N. and Vardas, P.E. (2002) Effect of acute atrial fibrillation on phasic coronary blood flow pattern and flow reserve in humans. European Heart Journal, 23, 734-741. http://dx.doi.org/10.1053/euhj.2001.2894
[32] Sciagrà, R., Sotgia, B., Olivotto, I., Cecchi, F., Nistri, S., Camici, P.G. and Pupi, A. (2009) Relationship between atrial fibrillation and blunted hyperemic myocardial blood flow in patients with hypertrophic cardiomyopathy. Journal of Nuclear Cardiology, 16, 92-96.
http://dx.doi.org/10.1007/s12350-008-9005-5
[33] Range, F.T., Paul, M., Schafers, K.P., Acil, T., Kies, P., Hermann, S., Schober, O., Breithardt, G., Wichter, T. and Schafers, M.A. (2009) Myocardial perfusion in nonischemic dilated cardiomyopathy with and without atrial fibrillation. Journal of Nuclear Medicine, 50, 390-396.
http://dx.doi.org/10.2967/jnumed.108.055665
[34] Smit, M.D., Tio, R.A., Slart, R.H., Zijlstra, F. and Van Gelder, I.C. (2010) Myocardial perfusion imaging does not adequately assess the risk of coronary artery disease in patients with atrial fibrillation. Europace, 12, 643-648.
http://dx.doi.org/10.1093/europace/eup404
[35] Abidov, A., Hachamovitch, R., Rozanski, A., Hayes, S.W., Santos, M.M., Sciammarella, M.G., Cohen, I., Gerlach, J., Friedman, J.D., Germano, G. and Berman, D.S. (2004) Prognostic implications of atrial fibrillation in patients undergoing myocardial perfusion single-photon emission computed tomography. Journal of the American College of Cardiology, 44, 1062-1070.
http://dx.doi.org/10.1016/j.jacc.2004.05.076

comments powered by Disqus

Copyright © 2014 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.