Patients with atrial fibrillation and coronary artery disease - Double trouble

Coronary artery disease (CAD) is the most common cardiovascular disease while atrial fibrillation (AF) is the most common cardiac arrhythmia. Both diseases share associated risk factors - hypertension, diabetes mellitus, sleep apnea, obesity and smoking. Moreover, inflammation plays a causative role in both diseases. The prevalence of CAD in patients with AF is from 17% to 46.5% while the prevalence of AF among patients with CAD is low and it is estimated from 0.2% to 5%. AF is a well-established factor of poor short- and long-term prognosis in patients with acute myocardial infarction (AMI) and is associated with a marked increase in overall mortality. The arrhythmia is common after cardiac surgeries and occurs in about 20 to 40% of patients after coronary artery bypass graft (CABG) surgery. It is predicted that between 5 and 15% of AF patients will require stenting at some point in their lives and will receive triple therapy with aspirin, clopidogrel or ticagrelor and oral anticoagulation (OAC). This requires careful consideration of antithrombotic therapy, balancing bleeding risk, stroke risk, and in-stent thrombosis with subsequent acute coronary syndromes. Co-prescription of OAC with antiplatelet therapy, in particular triple therapy, increases the absolute risk of major bleeding. In addition, major bleeding is associated with an up to 5-fold increased risk of death following an acute coronary syndrome. Coexistence of AF and CAD worsens the prognosis even in carefully treated patients.