Coronary Artery Disease in Cardiac Amyloidosis: Prevalence, Clinical Relevance, and Cardiac Magnetic Resonance Imaging Features

<b>Background/Objectives</b>: Cardiac amyloidosis (CA) as well as coronary artery disease (CAD) are both highly prevalent among the elderly. However, both the prevalence and risk factors associated with significant CAD among patients with CA, as well as potential outcome disparities, remain mainly unexplored. This study aimed to show the prevalence of CAD in patients with CA, as well as to assess outcomes and differences in late gadolinium enhancement (LGE) in comparison to patients with lone CA. <b>Methods</b>: We retrospectively assessed CA patients who underwent CAD assessment between 2013 and 2023. The primary endpoint was all-cause death. A subgroup underwent cardiac magnetic resonance imaging (CMR) with LGE assessment. <b>Results</b>: Of 255 consecutive patients with CA, 81 patients had significant CAD. Differences could be found with respect to age, sex, arterial hypertension, and hyperlipidemia. Significant differences in CMR features could only be found with respect to indexed left-ventricular end-diastolic volume, as well as left-ventricular mass. CAD-specific LGE was present only in 17.7% of patients with CAD, while most patients showed typical amyloid LGE, making a viability diagnosis difficult via CMR, especially in patients with end-stage CA. No differences in outcomes could be observed according to the prevalence of CAD. <b>Conclusions</b>: Concomitant obstructive CAD is highly prevalent among patients with CA. However, the presence of CAD does not influence patient outcomes. Furthermore, our data suggests that CAD viability testing by CMR might be complicated in patients with concomitant CA due to the high prevalence of amyloid-specific LGE.