title: Atrial fibrillation, progression of coronary atherosclerosis and myocardial infarction.
abstract: Background Despite atrial fibrillation representing an established risk factor for stroke, the association between atrial fibrillation and both progression of coronary atherosclerosis and major adverse cardiovascular events is not well characterized. We assessed the serial measures of coronary atheroma burden and cardiovascular outcomes in patients with and without atrial fibrillation. Methods Data were analyzed from nine clinical trials involving 4966 patients with coronary artery disease undergoing serial intravascular ultrasonography at 18-24 month intervals to assess changes in percent atheroma volume (PAV). Using a propensity weighted analysis, and following adjustment for baseline variables, patients with ( n = 190) or without ( n = 4776) atrial fibrillation were compared with regard to coronary plaque volume and major adverse cardiovascular events (death, myocardial infarction, and stroke). Results Atrial fibrillation patients demonstrated lower baseline PAV (36.0 ± 8.9 vs. 38.1 ± 8.9%, p = 0.002) and less PAV progression (-0.07 ± 0.34 vs. + 0.23 ± 0.34%, p = 0.001) compared with the non-atrial fibrillation group. Multivariable analysis revealed atrial fibrillation to independently predict both myocardial infarction [HR, 2.41 (1.74,3.35), p<0.001] 2.41 (1.74, 3.35), p < 0.00) and major adverse cardiovascular events [HR, 2.2, (1.66, 2.92), p<0.001] 2.20 (1.66, 2.92), p < 0.001]. Kaplan-Meier analysis showed that atrial fibrillation compared with non-atrial fibrillation patients had a significantly higher two-year cumulative incidence of overall major adverse cardiovascular events (4.4 vs. 2.0%, log-rank p = 0.02) and myocardial infarction (3.3 vs. 1.5%, log-rank p = 0.05). Conclusions The presence of atrial fibrillation independently associates with a heightened risk of myocardial infarction despite a lower baseline burden and progression rate of coronary atheroma. Further studies are necessary to define the pathogenesis of myocardial infarction in the setting of atrial fibrillation.
authors.affiliation: 1 Cleveland Clinic Coordinating Center for Clinical Research (C5R), USA.|2 Department of Cardiology, Celal Bayar University School of Medicine, Manisa, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Bayturan
authors.affiliation: 1 Cleveland Clinic Coordinating Center for Clinical Research (C5R), USA.|3 Department of Cardiovascular Medicine, Cleveland Clinic, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.affiliation: 3 Department of Cardiovascular Medicine, Cleveland Clinic, USA.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: 1 Cleveland Clinic Coordinating Center for Clinical Research (C5R), USA.
authors.forename: Mingyuan
authors.initials: M
authors.lastname: Shao
authors.affiliation: 1 Cleveland Clinic Coordinating Center for Clinical Research (C5R), USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Wolski
authors.affiliation: 3 Department of Cardiovascular Medicine, Cleveland Clinic, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Schoenhagen
authors.affiliation: 3 Department of Cardiovascular Medicine, Cleveland Clinic, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Kapadia
authors.affiliation: 1 Cleveland Clinic Coordinating Center for Clinical Research (C5R), USA.|3 Department of Cardiovascular Medicine, Cleveland Clinic, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Nissen
authors.affiliation: 4 South Australian Health and Medical Research Institute and Royal Adelaide Hospital, University of Adelaide, South Australia, Australia.
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.affiliation: 4 South Australian Health and Medical Research Institute and Royal Adelaide Hospital, University of Adelaide, South Australia, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications*; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors; D018084:Ultrasonography, Interventional
keywords: Intravascular ultrasound; atrial fibrillation; myocardial infarction