Relation of Atrial Fibrillation to Angiographic Characteristics and Coronary Artery Disease Severity in Patients Undergoing Percutaneous Coronary Intervention.

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Patients with atrial fibrillation (AF) have an increased risk of coronary artery disease (CAD) compared to patients without. Angiographic characteristics, clinical presentation and severity of CAD according to the presence of AF have been poorly described. We performed a retrospective study of 303 consecutive patients (mean age 69.6±10.8 years; 23.1% women) with and without AF undergoing percutaneous coronary intervention. Data on 1) type of CAD presentation, 2) coronary involvement and 3) number of diseased coronary vessels (≥70%/luminal narrowing) were collected. CHA2DS2-VASc and 2MACE scores were calculated. Presentation of CAD was STEMI in 37.6% of patients, NSTEMI-UA in 55.1%, and other in 7.3%. NSTEMI-UA was more common in AF (69.6% vs. 46.6%, p<0.001), while STEMI was more in the non-AF (22.3% vs. 46.6%, p<0.001) group. Left anterior descending artery (LAD) was the most common diseased vessel (70.6%) followed by right coronary artery (RCA, 56.4%) and obtuse marginal artery (36.6%). Patients with AF had a significantly lower RCA involvement (47.3% vs. 61.8%, p=0.016), with a trend for LAD (64.3% vs. 74.3%, p=0.069). At multivariable logistic regression analysis, AF remained inversely associated with RCA involvement (Odds Ratio [OR] 0.541, 95% Confidence Interval [CI] 0.335-0.874, p=0.012) and with ≥3 vessel CAD (OR 0.470, 95%CI 0.272-0.810, p=0.007). The 2 MACE score was associated with diseased LAD (OR 1.301, 95%CI 1.103-1.535, p=0.002) and with ≥3 vessel CAD (OR 1.330, 95%CI 1.330-1.140, p<0.001). In conclusion, patients with AF show lower RCA involvement and generally less severe CAD compared to non-AF ones. 2MACE score was higher in LAD obstruction and identified patients with severe CAD.

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