Atrial Fibrillation is More Frequently Associated with Non-Obstructive Coronary Lesions: The Bialystok Coronary Project

Introduction: Atrial fibrillation (AF) and chronic coronary syndromes (CCS) share common risk factors and both disease entities frequently co-exist. Additionally, AF symptoms may mimic CCS.

Objectives: To investigate the hypothesis indicating lack of significant coronary lesions in AF vs. sinus rhythm (SR) patients.

Patients and methods: We conducted a single-center retrospective study including consecutive patients referred for elective coronary angiography between 2007 and 2016.

Results: The study population comprised of 8,288 patients, including 1,674 with AF. There were substantial differences between groups with and without AF. AF patients were significantly older, more often male gender and diabetic, as well as more frequently were diagnosed with both chronic kidney disease and heart failure. On the other hand, they were less likely to have history of hyperlipidemia. CCS was less frequently detected in AF vs. SR patients (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 the lack of significant coronary lesions (odds ratio 1.57; 95% confidence interval 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).

Conclusions: In our study, AF was associated with lack of significant coronary lesions on angiography, reflecting difficulties with qualifying AF patients for invasive CCS diagnostics. Our findings suggest the need for development of more efficacious non-invasive diagnostic approach for AF patients with suspected CCS.