Beyond Coronary Risk: Clinical Scores as Predictors of Atrial Fibrillation in Chronic Coronary Syndrome

Atrial fibrillation frequently coexists with chronic coronary syndrome, sharing common cardiovascular risk factors and pathophysiological mechanisms. Identifying patients with chronic coronary syndrome at increased likelihood of atrial fibrillation remains clinically relevant, particularly in the absence of overt arrhythmia. Clinical and angiographic risk scores routinely used in coronary artery disease may capture cumulative cardiovascular and structural burden and could therefore assist in atrial fibrillation risk stratification. The ABC score provides a more accurate and individualized assessment of risk than traditional clinical scores in patients with AF. Materials and Methods: This prospective, single-center, proof-of-concept study included 131 consecutive patients undergoing invasive coronary angiography for suspected coronary ischemia were enrolled. Patients with and without atrial fibrillation were included, irrespective of arrhythmia subtype. Coronary artery disease severity was assessed using the Gensini and SYNTAX (PCI and CABG) scores. Global cardiovascular risk was evaluated using established clinical scores, including Framingham, ASCVD, SCORE2, and SCORE2-OP. Comparisons were performed between patients in sinus rhythm and those with different atrial fibrillation phenotypes. Correlation analyses, receiver operating characteristic curves, and multivariate logistic regression were applied to evaluate the association between risk scores, coronary disease severity, and atrial fibrillation. Results: Clinical and angiographic risk scores differed significantly according to rhythm status and atrial fibrillation subtype. Patients with atrial fibrillation exhibited higher values of global cardiovascular risk scores and greater coronary anatomical complexity compared with patients in sinus rhythm. The ABC score demonstrated the strongest discriminative performance for atrial fibrillation detection (AUC 0.908), followed by SYNTAX PCI and SYNTAX CABG. In multivariate analysis, the ABC score and SYNTAX CABG emerged as independent predictors of atrial fibrillation. Significant correlations were observed between traditional cardiovascular risk scores and SYNTAX-derived measures of coronary complexity, whereas correlations with the Gensini score were weaker. Established clinical and angiographic risk scores used in chronic coronary syndrome are associated with the presence and phenotype of atrial fibrillation. These findings support the potential role of routinely available risk scores as practical tools for identifying chronic coronary syndrome patients at increased likelihood of atrial fibrillation, facilitating targeted rhythm screening and early risk stratification.