The impact of atrial fibrillation on one-year mortality in patients with severe peripheral artery diseases

Abstract

Abstract Background Atrial fibrillation (Afib) was associated with the incidence of peripheral artery disease (PAD), but the effect of Afib on prognosis in patients with severe PAD remains unclear. Purpose We aimed to investigate the association between Afib and clinical outcomes. Methods We retrospectively enrolled consecutive patients with severe PAD receiving percutaneous transluminal angioplasty between 2013/1/1 and 2018/12/31. The study outcomes were all-cause mortality, cardiac-related mortality, major adverse cardiac events (MACE), and major adverse limb events (MALE) at one-year. Results The study consisted of 222 patients with age 74±11 years, the stage of Rutherford classification 4.6±0.8, 54% male, and 12.6% presented with acute limb ischemia. The patients with Afib vs. without Afib had significantly greater ratios of all-cause mortality (42.9% vs. 20.1%, P=0.014) and MACE (32.1% vs. 14.4%, P=0.028). A trend toward significant association was found regarding one-year cardiac mortality (21.4% vs. 10.3%, P=0.111). No significant difference was found with respect of MALE (17.9% vs. 14.9%, P=0.778). After we adjusted for confounders in each study outcome, Afib was independently associated with all-cause mortality (adjusted HR: 2.153, 95% CI: 1.084–4.276, P=0.029) and MACE (adjusted HR: 2.338, 95% CI: 1.054–2.188, P=0.037). Other predictors associated with all-cause mortality included the presence of acute limb ischemia (adjusted HR: 2.898, 95% CI: 1.504–5.586, P=0.001), Rutherford classification (adjusted HR: 1.930, 95% CI: 1.191–3.128, P=0.008), and heart rate (adjusted HR: 1.018, 95% CI: 1.001–1.035, P=0.035). The other predictor associated with MACE was heart rate (adjusted HR: 1.020, 95% CI: 1.002–1.037, P=0.025) Conclusions Afib was significantly associated with increased risks of all-cause mortality and MACE at one year in the patients with severe PAD, and future studies may investigate whether use of oral anti-coagulants benefits to these patients. Funding Acknowledgement Type of funding source: None