Prognostic Value of Subclinical Coronary Artery Disease in Atrial Fibrillation Patients Identified by Coronary Computed Tomography Angiography

Autor: Paul Musters, Ricardo P.J. Budde, Fay M. A. Nous, Eva D. van Dijkman, Koen Nieman, Tjebbe W. Galema
Přispěvatelé: Cardiology, Radiology & Nuclear Medicine
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Computed Tomography Angiography
Angiotensin-Converting Enzyme Inhibitors
Coronary Artery Disease
030204 cardiovascular system & hematology
Coronary Angiography
Risk Assessment
Coronary artery disease
03 medical and health sciences
Angiotensin Receptor Antagonists
0302 clinical medicine
Internal medicine
Atrial Fibrillation
medicine
Humans
cardiovascular diseases
030212 general & internal medicine
Vascular Calcification
Subclinical infection
Computed tomography angiography
Aged
Retrospective Studies
medicine.diagnostic_test
business.industry
Vascular disease
Coronary Stenosis
Anticoagulants
Retrospective cohort study
Atrial fibrillation
Middle Aged
medicine.disease
Prognosis
Coronary Calcium Score
Stenosis
Cardiology
Female
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Follow-Up Studies
Zdroj: American Journal of Cardiology, 126, 16-22. Elsevier Inc.
ISSN: 0002-9149
DOI: 10.1016/j.amjcard.2020.03.050
Popis: Identifying coronary artery disease (CAD) in atrial fibrillation (AF) patients improves risk stratification and defines clinical management. However, the value of screening for subclinical CAD with cardiac CT in AF patients is unknown. Between 2011 and 2015, 94 consecutive patients without known or suspected CAD (66 (57-73) years, 68% male), who were referred for AF evaluation, underwent a noncontrast-enhanced coronary calcium scan and a coronary computed tomography angiography (CCTA) at our center. We retrospectively evaluated the coronary calcium score, the prevalence of obstructive CAD (≥50% stenosis) determined by CCTA, compared clinical management and 5-year outcome in patients with and without obstructive CAD on CCTA, and examined the potential impact of a coronary calcium score and obstructive CAD on CCTA as a manifestation of vascular disease on the CHA2Ds2VASc score and for the cardiovascular risk stratification of AF patients. The median coronary calcium score was 57 (0-275) and 24 patients (26%) had obstructive CAD on CCTA. At baseline, patients with obstructive CAD more often used statins than those without obstructive CAD (54% vs 26%, p = 0.011). After a median clinical follow-up of 2.4 (0.5-4.5) years, patients with obstructive CAD more frequently used oral anticoagulant and/or antiplatelet drugs, statins, angiotensin-II-receptor blockers and/or angiotensin-converting-enzyme inhibitors, and less often used class I antiarrhythmic drugs than patients without obstructive CAD (all p0.050). After a median follow-up of 5.7 (4.8-6.8) years, mortality was higher in patients with obstructive CAD than in those without obstructive CAD (29% vs 11%, log-rank test: p = 0.034). Implementation of a coronary calcium score and/or obstructive CAD on CCTA elevated the CHA2Ds2VASc score and cardiovascular risk stratification in 42 patients (p0.001) and 47 patients (p = 0.006), respectively. In conclusion, we observed a high prevalence of obstructive CAD on CCTA in AF patients without known or suspected CAD. AF patients with obstructive CAD were managed differently and had a worse prognosis than those without obstructive CAD. Cardiac CT could enhance cardiovascular risk stratification of AF patients.
Databáze: OpenAIRE
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