Published Online
on January 26, 2009

A more recent version of this article appeared on March 1, 2009

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Original Article

Prevalence of coronary artery disease assessed by multi-slice computed tomography coronary angiography in patients with paroxysmal or persistent atrial fibrillation

Gaetano Nucifora¹; Joanne D. Schuijf¹; Laurens F. Tops¹; Jacob M. van Werkhoven¹; Sami Kajander²; J. Wouter Jukema¹; Joop H.M. Schreur³; Mark W. Heijenbrok³; Serge A. Trines¹; Oliver Gaemperli⁴; Olli Turta²; Philipp A. Kaufmann⁴; Juhani Knuuti⁵; Martin J. Schalij¹ and Jeroen J. Bax^1,6

¹ Leiden University Medical Center, Leiden, The Netherlands;
² Turku PET Center, Turku University Central Hospital, Turku, Finland;
³ Medisch Centrum Haaglanden, Leidschendam, The Netherlands;
⁴ Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland;
⁵ Turku University Central Hospital, Turku, Finland

⁶ E-mail: j.j.bax{at}lumc.nl

Background—Although atrial fibrillation (AF) has been linked to underlying coronary artery disease (CAD), data supporting this association have been based on ECG and clinical history for the definition of CAD rather than direct visualization of atherosclerosis.

Methods and Results—The prevalence of CAD among patients with paroxysmal or persistent AF and without history of CAD was evaluated using multi-slice computed tomography (MSCT). MSCT was performed in 150 AF patients (61±11 years, 67% male, 58% asymptomatic) with predominantly low (59%) or intermediate (25%) pre-test likelihood of CAD. CAD was classified as obstructive (50% luminal narrowing) or not. A population of 148 patients without history of AF, similar to the AF group as to age, gender, symptomatic status and pre-test likelihood, served as a control group. Logistic regression analysis was applied to evaluate the relationship between demographic and clinical data and the presence of obstructive CAD. Based on MSCT, 18% of AF patients were classified as having no CAD, whereas 41% showed non-obstructive CAD and the remaining 41% had obstructive CAD. Among non-AF patients, 32% were classified as having no CAD, while 41% showed non-obstructive CAD and 27% had obstructive CAD (p=0.010 compared to AF patients). At logistic regression analysis, age, male gender and the presence of AF were significantly related to obstructive CAD.

Conclusion—A higher prevalence of obstructive CAD was observed among AF patients, confirming the hypothesis that AF could be a marker of advanced coronary atherosclerosis.

Key Words: coronary disease • atrial fibrillation • multi-slice computed tomography • prevalence • risk stratification

Related Article

Prevalence of Coronary Artery Disease Assessed by Multislice Computed Tomography Coronary Angiography in Patients With Paroxysmal or Persistent Atrial Fibrillation

Gaetano Nucifora, Joanne D. Schuijf, Laurens F. Tops, Jacob M. van Werkhoven, Sami Kajander, J. Wouter Jukema, Joop H.M. Schreur, Mark W. Heijenbrok, Serge A. Trines, Oliver Gaemperli, Olli Turta, Philipp A. Kaufmann, Juhani Knuuti, Martin J. Schalij, and Jeroen J. Bax
Circ Cardiovasc Imaging 2009 2: 100-106. [Abstract] [Full Text] [PDF]