The incidence of coronary artery disease in patients with symptomatic bradyarrhythmias

Symptomatic bradyarrhythmia occurs most often in aged patients. Most of the se patients have multiple coronary risk factors and present with angina-lik e symptoms. The coexistence of CAD not only has major effects on their prog nosis but also influences the long-term care, This study was designed to ev aluate the incidence of coexistent CAD in patients with symptomatic bradyar rhythmias and its relationship to conventional coronary risk factors in Chi nese people. From May 1996 to April 1998t we prospectively studied all consecutive patie nts admitted to our institution for symptomatic bradyarrhythmias requiring permanent pacemaker implantation. Coronary angiographies were performed non -selectively at the same session of pacemaker implantation. Based on the pr esence or absence of CAD, patients,were divided into two groups for analysi s. Multivariate logistic regression analysis was performed to determine ind ependent predictors of CAD including sex, age, diabetes melitus (DM), hyper tension. hypercholesterolemia. and smoking. The odds-ratio (OR) and 95% con fidence interval (Cl) were determined. A total of 113 patients [68 males and 45 females, mean age 70.4 +/-8.2 year s old (range 45-86)] were included in our study. The diagnosis was sick sin us syndrome in 69 patients (61%) and atrioventricular block in 44 patients (39%). The incidence of CAD based on coronary angiography was 20%. The noda l-related artery was seldom involved among patients with coexistent CAD and symptomatic bradyarrhythmias (9%), and most patients had significant steno sis over LAD (74%). The baseline characteristics and presenting symptoms we re not different statistically between patients with or without CAD. Hyperc holesterolemia (OR 6.6. 95% CI 2.0-22.2, p=0.002) and DM (OR 4.7 95%, CI 1. 3-17.2, p=0.020) were the two most significant independent predictors of CA D. In our patients with symptomatic bradyarrhythmias requiring permanent cardi ac pacing, the incidence of CAD was 20% as determined by coronary angiograp hy (CAG). Hypercholesterolemia and DM were the two most significant indepen dent predictors for CAD in these patients. The nodal artery was seldom invo lved in patients with coexistent CAD and symptomatic bradyarrhythmias.