Document Detail


Effect of atrial fibrillation on outcome in patients with known or suspected coronary artery disease referred for exercise stress testing.
MedLine Citation:
PMID:  20403467     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The association of atrial fibrillation (AF) with coronary artery disease (CAD) remains controversial. In addition, the relation of AF to myocardial ischemia and outcomes in patients with known or suspected CAD referred for exercise stress testing has been poorly explored. In this study, 17,100 patients aged > or = 50 years with known or suspected CAD who underwent exercise electrocardiography (n = 11,911) or exercise echocardiography (n = 5,189) were evaluated. End points were all-cause mortality, nonfatal myocardial infarction, and coronary revascularization. Overall, 619 patients presented with AF at the time of the tests. Patients with AF who had interpretable electrocardiograms had a lower likelihood of exercise-induced ischemic ST-segment abnormalities (adjusted odds ratio 0.51, 95% confidence interval 0.34 to 0.76, p = 0.001), and those with AF who underwent exercise echocardiography had a lower likelihood of new or worsening exercise-induced wall motion abnormalities (adjusted odds ratio 0.62, 95% confidence interval 0.44 to 0.87, p = 0.006). During a mean follow-up period of 6.5 + or - 3.9 years, 2,364 patients died, 1,311 had nonfatal myocardial infarctions, 1,615 underwent percutaneous coronary intervention, and 922 underwent coronary artery bypass surgery. The 10-year mortality rate was 43% in patients with AF compared to 19% in those without AF (p <0.001). In multivariate analysis, AF remained an independent predictor of all-cause mortality (adjusted hazard ratio 1.45, 95% confidence interval 1.20 to 1.76, p <0.001), but not of nonfatal myocardial infarction or coronary revascularization. In conclusion, despite being associated with an apparently lower likelihood of myocardial ischemia, AF was an independent predictor of all-cause mortality in patients with known or suspected CAD referred for exercise stress testing.
Authors:
Alberto Bouzas-Mosquera; Jes?s Peteiro; Francisco J Broull?n; Nemesio Alvarez-Garc?a; Victor X Mosquera; Sheyla Casas; Alberto P?rez; Elizabet M?ndez; Alfonso Castro-Beiras
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-03-11
Journal Detail:
Title:  The American journal of cardiology     Volume:  105     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-20     Completed Date:  2010-06-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1207-11     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiology, Hospital Universitario A Coru?a, A Coru?a, Spain. aboumos@canalejo.org
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / complications*,  mortality,  physiopathology
Cause of Death / trends
Confidence Intervals
Coronary Angiography
Coronary Artery Disease / complications,  diagnosis*,  surgery
Diagnosis, Differential
Electrocardiography / methods*
Exercise Test / methods*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Revascularization*
Retrospective Studies
Spain / epidemiology
Survival Rate / trends
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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