Indicators of coronary angiography in patients with acute coronary syndrome and atrial fibrillation
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Abstract
The aim – to study the features of coronary artery (CA) deficiency (according to the results of selective coronary angiography) in patients with acute coronary syndrome (ACS) and atrial fibrillation (AF).
Materials and methods. 125 patients who were hospitalized with ACS at the center of percutaneous coronary interventions during four years (2015–2018) were examined. 65 of them had AF. The criterion for inclusion in the study was the presence of ACS; exclusion criteria were the presence of severe concomitant diseases (active oncological processes, chronic renal failure grade IV, etc.), heart disease, refusal of the patient to participate in the study. The patients were divided into groups according to the presence of AF. Group 1 included patients with AF. Those of them who had the first AF onset during the hospitalization with ACS constituted subgroup 1a (n=41). Patients in whom AF was observed prior to the development of ACS composed subgroups 1b (n=24). Group 2 included patients without AF in anamnesis and during hospitalization (n=60).
Results and discussion. The presence of AF in the development of ACS is associated with widespread atherosclerotic damage to CA, a multicentric lesion, statistically significantly greater than the average number of plaques per patient (2.87±0.46 vs. 2.31±0.34; p=0.00001), greater average number of affected segments per patient (2.78±0.42 vs. 2.43±0.37; p=0.0015), higher average number of hemodynamically significant stenoses of CA (2.22±0.33 vs. 1.60±0.24; p=0.00001) and damage to the proximal parts of CA (p=0.0001).
Conclusions. The complication of the course of ACS by the development of the first episode of atrial fibrillation is more common in patients with angiographically intact coronary vessels, under condition of single-vessel atherosclerotic lesions of CA and involvement of the left CA in the atherosclerotic process. In patients with ACS and AF emerging for the first time, the level of NT-proBNP is higher compared to the group of patients without AF and to the group of patients with AF preceding the development of ACS, especially in patients with single-vessel CA damage.
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