title: Predictive accuracy of ST depression during rapid atrial fibrillation on the presence of obstructive coronary artery disease.
abstract: BACKGROUND
  Rapid atrial fibrillation (AF) is commonly associated with ST-segment depressions. ST-segment depression during a chest pain episode or exercise stress testing in sinus rhythm is predictive of obstructive coronary artery disease (CAD), but it is unclear if the presence or magnitude of ST-segment depression during rapid AF has similar predictive accuracy.
  
  
  METHODS
  One hundred twenty-seven patients with rapid AF (heart rate ≥120 beats per minute) who had cardiac catheterization performed during the same hospital admission were retrospectively reviewed. Variables to compute thrombolysis in myocardial infarction (TIMI) risk score, demographic profiles, ST-segment deviation, cardiac catheterization results, and cardiac interventions were collected.
  
  
  RESULTS
  Thirty-five patients had ST-segment depression of 1 mm or more, and 92 had no or less than 1 mm ST depression. Thirty-one patients were found to have obstructive CAD. In the group with ST-segment depression, 11 (31%) patients had obstructive CAD and 24 (69%) did not. In the group with less than 1 mm ST-segment depression, 20 (22%) had obstructive CAD and 72 (78%) did not (P = .25). Sensitivity, specificity, and positive and negative predictive values for presence of obstructive CAD were 35%, 75%, 31%, and 78%, respectively. The presence of ST-segment depression of 1 mm or more was not associated with presence of obstructive CAD before or after adjustment of TIMI variables. The relationship between increasing grades of ST-segment depression and obstructive CAD showed a trend toward significance (P = .09), which did not persist after adjusting for TIMI risk variables (P = .36).
  
  
  CONCLUSIONS
  ST-segment depression during rapid AF is not predictive for the presence of obstructive CAD.
authors.affiliation: Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. rajesh.pradhan@jeffersonhospital.org
authors.forename: Rajesh
authors.initials: R
authors.lastname: Pradhan
authors.forename: Ashok
authors.initials: A
authors.lastname: Chaudhary
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Donato
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D054059:Coronary Occlusion / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity