Observational Study Of The Relationship Between Significant Lesion Of Proximal Coronary Artery And Atrial Fibrillation

Objective:Analyse the clinical characteristics as well as the features of coronary artery lesions in coronary artery diseased patients complicated with atrial fibrillation; investigate the relationship between the diseased proximal sections of the main branches of coronary artery and the severity of the risk of atrial fibrillation.Methods:253 patients are enrolled and divided into atrial fibrillation group(n=25) and sinus rhythm group(n=228) according to their EKG or Holter diagnosis before they undergo coronary angiography. Clinical characteristics and coronary artery disease files are compared using chi-square test or t-test respectively according to the type of variables,as well as regression analysis between the two groups.228 patients with Sinus rhythm are divided according to the results of this averaged 6-year-after follow-up into newly developed atrial fibrillation group (n=7), and sinus rhythm group (n=214); according to whether or not with a history of hypertension they are divided into hypertension group and normal blood pressure group; according to the different clinical cardiovascular events divided into MI group and non-MI group; according to the number of proximal diseased vessels they are divided into no proximal diseased vessel group(n=5),1-vessel proximally diseased group (n=71), 2-vessel proximally diseased group (n=66),3 or more vessels proximally diseased group (n=119). Comparison of count data between groups usingχ2 test; measurement data using t test. Logistic regression analysis is used to compare the main branch of the proximal coronary lesions and other risk factors including age, hypertension history, history of previous myocardial infarction, hs-CRP, left atrial diameter, left ventricular ejection fraction and the number of coronary angiography proved vascular lesions between groups to evaluate their risks to atrial fibrillation occurrence.Results:Compared by chi-square test,preoperative AF group and preoperative sinus rhythm with coronary heart disease group showed so no significant differences in sex, history of hypertension, diabetes, and smoking history, but the incidence of previous myocardial infarction showed statistically significant difference(p=0.003), the preoperative atrial fibrillation group has higher occurrence than preoperative sinus rhythm group. The independent sample-t test showed that age (p=0.001), TG (P= 0.001), and left atrial diameter (p<0.001) drawn significant difference. Age, left atrial diameter was higher in AF group than in SR group, while the TG level lower than the sinus rhythm group. Between the two groups, the incidence of proximally diseased left anterior descending artery is meaningless by chi-square test(P=0.611), but LCXp (p= 0.001), RCAp (p<0.001) lesions are significantly higher in AF group than preoperative sinus group, which is statistically significant.For logistic regression analysis, age, history of previous myocardial infarction, TG level, occurrence of LADp, RCAp lesions are of no significant difference between the two groups, only left atrial diameter (p<0.001) is still significantly different. Preoperative sinus rhythm group is divided into newly developed atrial fibrillation (NDAf) group and SR(non-NDAf)group according to the result of the averaged 6-year-after follow-up, two groups of basic clinical data including gender (p=0.574), age (p=0.154), history of hypertension (p=0.243), diabetes history (p=0.680), previous history of acute myocardial infarction (p= 0.422) and smoking (p=0.431) as well as fasting blood glucose, total cholesterol, triglyceride, LDL-ch (low density lipoprotein), HDL- ch (high density lipoprotein), serum hs-CRP indicate no significant difference. Left atrial diameter of NDAf group is statistically greater than the non-NDAf group (p=0.015), SYNTAX score higher than the sinus rhythm group (p=0.020), more diseased coronary arteries (p<0.05), and higher occurrence of left circumflex (P<0.05), right coronary proximal (P<0.05) lesions compared with non-NDAf group. Logistic regression analysis further found that left atrial diameter (p=0.007) and proximal right coronary lesions (p=0.036) are associated with the occurrence of atrial fibrillation, while the SYNTAX score, coronary arteries, proximal circumflex artery disease have not significance.Conclusion:Left atrial size is an independent risk factor for atrial fibrillation accompanied with or without coronary heart disease. Plasma TG level is risk factors for coronary heart disease, and it may be related to the severity of coronary artery disease, but not related to the occurrence of atrial fibrillation. Significant lesion of proximal right coronary artery is a risk factors for atrial fibrillation secondary to coronary heart disease, and gender, age, history of hypertension, previous myocardial infarction, left ventricular function and proximal anterior descending coronary artery lesions in crowd with significant proximal coronary heart disease are of no predictive significance to atrial fibrillation...