PhD Scientific Days 2025

Cardiovascular Medicine and Research II.

Intervention of Stable Coronary Artery Disease in Patients with Atrial Fibrillation

Name of the presenter

Maraczi Daniel

Institute/workplace of the presenter

Semmelweis University, Heart and Vascular Centre

Authors

Daniel Maraczi¹, Tamas Koleszar¹, Nandor Szegedi¹, Balint Szilveszter¹, Osztheimer Istvan¹, Alexisz Panajotu¹, Gabor Szeplaki², Adam Levente Jermendy¹, Laszlo Geller¹, Bela Merkely¹, Szilvia Herczeg¹, Zsofia Dora Drobni¹

1: Semmelweis University, Heart and Vascular Centre
2: Mater Private Hospital and Royal College of Surgeons in Ireland

Text of the abstract

Introduction
Atrial fibrillation (AF) patients undergoing catheter ablation have an 8-10% prevalence of obstructive coronary artery disease (OCAD) visualized by cardiac CT angiography (CCTA). There is no clear data on the impact of percutaneous coronary intervention (PCI) of OCAD on the success rate of ablation and cardiovascular (CV) complications.
Aims
This study aimed to determine whether revascularization of OCAD detected by CCTA before ablation improves ablation success and CV event rates.
Method
This retrospective study examined patients who were referred for invasive coronary angiography (ICA) and/or had been diagnosed with at least one coronary artery stenosis of >70%, based on their CCTA findings between 2014 and 2024 (n=372). We analyzed their ICA findings, AF recurrence, and CV complications within a standardized 2-year follow-up period. We defined a composite endpoint as the sum of ischemic and major bleeding events, CV hospitalizations, and mortality. Patients were excluded from the analysis if they had follow-up shorter than one year or underwent coronary artery bypass surgery. Statistical analysis was conducted in RStudio, with a significance level set at p<0.05.
Results
Among the 275 patients undergoing ablation included for analysis, 178 also underwent ICA, with only 48% requiring PCI. Of the interventions, 49/86 (57%) were performed after the ablation and 37/86 (43%) before. Median age was 67 (interquartile range: 62-72) years and 100/275 (36%) of them were female. 96/275 (35%) patients had a diagnosis of persistent AF and 179/275 (65%) of paroxysmal at the time of CCTA. The 2-year incidence of acute coronary syndrome (ACS) was significantly higher in the group not undergoing ICA compared to the group that underwent ICA. (6/97 [6.2%] vs 1/178 [0.6%], p=0.009). Also, the 2-year incidence of the composite endpoint was significantly higher in the PCI after ablation group compared to the PCI before ablation group (11/49 [22%] vs 2/37 [5.4%], p=0.029).
Conclusion
Performing ICA may decrease the incidence of ACS in AF patients with severe luminal stenosis visualized by pre-ablation CCTA, and the timing of PCI may also impact outcomes. Additionally, the high (52%) rate of non-significant ICA results highlights the need for further optimization of CCTA image quality in AF patients, especially those with OCAD.
Funding
We declare no funding.