Long-term prognostic impact of atrial fibrillation subtypes in unselected patients undergoing coronary angiography

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.