Thromboembolic Risk of Imaging-Confirmed Coronary Artery Disease Without Myocardial Infarction in Patients With Nonvalvular Atrial Fibrillation

摘要

The implication of coronary artery disease (CAD) without the clinical manifestation of myocardial infarction (non-MI-CAD) on thromboembolic events in patients with nonvalvular atrial fibrillation (NVAF) is not well evaluated. We hypothesized that non-MI-CAD would have a similar risk of future thromboembolism as MI-CAD. Clinical data for 17,073 consecutive patients (mean age, 64.3 years; males, 64.9 %) diagnosed with NVAF at our center were analyzed. CAD was defined as stenosis of >= 50% stenosis of major coronary arteries identified using coronary artery angiography or coronary computed tomographic angiography. The main outcome of the present study was the rate of thromboembolic events (ischemic stroke and systemic embolism) during the follow-up period (3.1 +/- 2.4 years). A total of 1,011 patients (5.9 %) were diagnosed with CAD without clinical manifestation of MI (non-MI-CAD) and 708 (4.1 %) had a history or diagnosis of MI-CAD. Thromboembolic events occurred in 1,007 patients (5.9%) during follow-up. The groups were at high risk of future thromboembolic events determined using univariate (hazard ratio [HR] 1.55; 95% confidence interval [CI] 1.25 to 1.91; p <0.001 for non MI-CAD and HR 2.14; 95% CI 1.70 to 2.69; p <0.001 for MI-CAD) and multivariate analysis adjusted for CHA(2)DS(2)-VASc score components and relevant variables (HR 1.42; 95% CI 1.15 to 1.77; p = 0.001 for non-MI-CAD and HR 1.62; 95% CI 1.28 to 2.06; p <0.001 for MI-CAD); this trend was consistent in patients who did not receive anticoagulants during follow-up (n = 8,032, 47.0%). In conclusion, non-MI-CAD is an important predictor of thromboembolic events in patients with NVAF. (C) 2019 Elsevier Inc. All rights reserved.