Abstract
Objective
To evaluate the long-term prognostic impact of atrial fibrillation and its subtypes in an unselected cohort undergoing coronary angiography.
Background
Atrial fibrillation is common in patients undergoing coronary angiography and linked to adverse outcomes, but the long-term prognostic impact of atrial fibrillation subtypes, particularly regarding heart failure risk, remains unclear.
Methods
Patients undergoing coronary angiography from 2016 to 2022 were stratified by atrial fibrillation status and subtype (paroxysmal, persistent, permanent, new-onset). The primary endpoint was heart failure-related rehospitalization at 36 months. Secondary endpoints included coronary revascularization, acute myocardial infarction (AMI), and in-hospital all-cause mortality.
Results
Among 7529 patients, 26.8% had atrial fibrillation (i.e. paroxysmal: 37.7%; persistent: 14.8%, permanent: 16.6%, and new-onset atrial fibrillation: 31.0%). Compared with patients without atrial fibrillation, atrial fibrillation patients were older (median 76 vs. 67 years;
P
= 0.001) and had higher rates of heart failure, chronic kidney disease, and acute heart failure. At 36 months, heart failure–related rehospitalization occurred more frequently in atrial fibrillation patients (30.2 vs. 18.4%;
P
= 0.001), whereas AMI rates were similar, and coronary revascularization rates were lower. Atrial fibrillation was independently associated with heart failure–related rehospitalization (hazard ratio = 1.246, 95% confidence interval: 1.108–1.400,
P
= 0.001), but not with coronary revascularization or AMI. H eart failure rehospitalization increased stepwise across atrial fibrillation subtypes, with the highest in permanent atrial fibrillation (42.5%;
P
= 0.001) and progressively lower risk in persistent (34.8%;
P
= 0.001), paroxysmal (26.9%;
P
= 0.001), and new-onset atrial fibrillation (23.6%;
P
= 0.002).
Conclusion
Atrial fibrillation independently predicts long-term heart failure–related rehospitalization after coronary angiography, highest in permanent followed by persistent atrial fibrillation.