Coronary Artery Disease among Patients who are Admitted with Atrial Fibrillation and Chest Pain

Introduction:
A considerable number of patients present with chest pain during an episode of atrial fibrillation (AF). Whether chest pain or other clinical, electrocardiographic or laboratory markers are signs of unmasked coronary artery disease (CAD) is a debatable question.
Methods:
The aim of this study was to identify clinical, imaging or laboratory markers which can predict significant CAD among patients with AF episode and chest pain. This study included 44 patients who were admitted with AF and chest pain. All patients underwent coronary evaluation by cardiac CT (Computed Tomography) or by angiography. Significant CAD was defined as a stenosis>50% in major coronary artery. We preformed statistical analysis comparing CAD and non-CAD groups by t-test, Mann-Whitney-U test or chi-square test, and analyzed risk factors by regression analysis.
Results:
Nineteen patients (43%) were diagnosed with significant CAD and 25 patients (57%) without obstructive CAD (non-CAD). There were no significant differences regarding typical chest pain presentation in CAD [11 (58%)] vs. the non-CAD group [17 (68%)] (p=0.21), or in ECG changes: 10 (53%) vs. 7 (28%) respectively (p=0.1). In the CAD group there was higher maximal troponin level [120(30,0.5) ng/dL] than in the non-CAD group [34(15,135) ng/dL] (p =0.029). There was also a higher prevalence of regional wall motion abnormality (RWMA) in the CAD group: 10 (53%) vs. 3 (12%) in the non-CAD (p=0.014). Among the CAD group, the coronary disease was multi-vessel in 15 (79%) patients and involved mostly proximal segments of the coronary tree. Maximal troponin and RWMA were found to be predictors for CAD with HR 6.5 CI 1.6-26.8 (p=0.01) and HR 8.3 CI 1.8-38.4 (p=0.007), respectively.
Conclusion:
Clinical symptoms such as chest pain and ECG changes are subjective and are not highly reliable tools for evaluation of chest pain in patients with AF. Troponin and RWMA are helpful in the diagnosis of obstructive CAD in patients with AF.