Atrial fibrillation in outpatients with stable coronary artery disease: results from the multicenter RECENT study

INTRODUCTION Atrial fibrillation (AF) frequently coexists with other cardiovascular diseases.

OBJECTIVES The aim of this study was to assess the prevalence of AF in outpatients with stable coronary artery disease (CAD) and to determine clinical and laboratory parameters associated with the higher prevalence of this arrhythmia. In addition, we compared the indications for antithrombotic treatment using the older CHADS2 and the currently used CHA2DS2-VASc scores.

PATIENTS AND METHODS We studied the clinical data of 2578 Polish patients with stable CAD participating in the multicenter RECENT study (age, 65 ±10 years; men, 55%; Canadian Cardiovascular Society class I/II/III+IV, 38%/48%/14%).

RESULTS AF was present in 19% of patients with CAD. Advanced age, longer history of CAD, and concomitant heart failure were independently associated with the higher prevalence of AF (all P <0.05). Among patients with CAD and AF, 73% of the patients required antithrombotic treatment according to the CHADS2 score (≥2), and 94%—according to the CHA2DS2-VASc score (≥2). A CHA2DS2-VASc score of 2 or higher was found in 47% of the patients with a CHADS2 score of 0 and 85% of those with a CHADS2 score of 1. Twenty-one percent of patients with CAD and AF did not have unequivocal indications for antithrombotic treatment according to the CHADS2 score (0–1), while they had strong indications for such treatment on the basis of the CHA2DS2-VASc score (≥2). 

CONCLUSIONS AF affects every fifth ambulatory patient with CAD. According to the CHA2DS2-VASc score, almost all patients with CAD and AF require antithrombotic treatment, which may complicate coronary revascularization and related antiplatelet treatment.