The Impact of Atrial Fibrillation on One-Year Mortality in Patients with Severe Lower Extremity Arterial Disease

Overview

Journal J Clin Med

Specialty General Medicine

Date 2022 Apr 12

PMID 35407544

Authors

Min-I Su

Ying-Chih Cheng

Yu-Chen Huang

Cheng-Wei Liu

Affiliations

Soon will be listed here.

Abstract

Atrial fibrillation (Afib) is associated with the presence of lower extremity arterial disease (LEAD), but its effect on a severe LEAD prognosis remains unclear. We investigated the association between Afib and clinical outcomes. We retrospectively enrolled consecutive severe LEAD patients undergoing percutaneous transluminal angioplasty between 1 January 2013 and 31 December 2018. Patients were divided according to the history of any type of Afib and followed for at least one year. The primary outcome was all-cause mortality. Secondary outcomes were cardiac-related mortality and major adverse cardiovascular events (MACEs). The study included 222 patients aged 74 ± 11 years (54% male), and 12.6% had acute limb ischemia. The Afib group had significantly higher rates of all-cause mortality (42.9% vs. 20.1%, = 0.014) and MACEs (32.1% vs. 14.4%, = 0.028) than the non-Afib group. Afib was independently associated with all-cause mortality (adjusted HR: 2.153, 95% CI: 1.084-4.276, = 0.029) and MACEs (adjusted HR: 2.338, 95% CI: 1.054-2.188, = 0.037). The other factors associated with all-cause mortality included acute limb ischemia (adjusted HR: 2.898, 95% CI: 1.504-5.586, = 0.001), Rutherford classification, and heart rate. Afib was significantly associated with increased risks of one-year all-cause mortality and MACEs in patients with severe LEAD. Future studies should investigate whether oral anticoagulants benefit these patients.

Citing Articles

Clinical Characteristics and Predictors of Long-Term Prognosis of Acute Peripheral Arterial Ischemia Patients Treated Surgically.

Myrcha P, Kozak M, Myrcha J, Zabek M, Rocha-Neves J, Glowinski J Int J Environ Res Public Health. 2023; 20(5).

PMID: 36900887 PMC: 10001670. DOI: 10.3390/ijerph20053877.

References

Hess C, Huang Z, Patel M, Baumgartner I, Berger J, Blomster J . Acute Limb Ischemia in Peripheral Artery Disease. Circulation. 2019; 140(7):556-565. DOI: 10.1161/CIRCULATIONAHA.119.039773. View

Hicks C, Yang C, Ndumele C, Folsom A, Heiss G, Black 3rd J . Associations of Obesity With Incident Hospitalization Related to Peripheral Artery Disease and Critical Limb Ischemia in the ARIC Study. J Am Heart Assoc. 2018; 7(16):e008644. PMC: 6201405. DOI: 10.1161/JAHA.118.008644. View

Hu P, Lopes R, Stevens S, Wallentin L, Thomas L, Alexander J . Efficacy and Safety of Apixaban Compared With Warfarin in Patients With Atrial Fibrillation and Peripheral Artery Disease: Insights From the ARISTOTLE Trial. J Am Heart Assoc. 2017; 6(1). PMC: 5523640. DOI: 10.1161/JAHA.116.004699. View

Murata N, Soga Y, Iida O, Yamauchi Y, Hirano K, Kawasaki D . Complex relationship of body mass index with mortality in patients with critical limb ischemia undergoing endovascular treatment. Eur J Vasc Endovasc Surg. 2014; 49(3):297-305. DOI: 10.1016/j.ejvs.2014.10.014. View

Global BMI Mortality Collaboration , Di Angelantonio E, Bhupathiraju S, Wormser D, Gao P, Kaptoge S . Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016; 388(10046):776-86. PMC: 4995441. DOI: 10.1016/S0140-6736(16)30175-1. View

Chang C, Chen Y, Liu C, Lin W, Lin C, Lin M . Atrial Fibrillation Increases the Risk of Peripheral Arterial Disease With Relative Complications and Mortality: A Population-Based Cohort Study. Medicine (Baltimore). 2016; 95(9):e3002. PMC: 4782906. DOI: 10.1097/MD.0000000000003002. View

Bonaca M, Bauersachs R, Anand S, Sebastian Debus E, Nehler M, Patel M . Rivaroxaban in Peripheral Artery Disease after Revascularization. N Engl J Med. 2020; 382(21):1994-2004. DOI: 10.1056/NEJMoa2000052. View

Wasilewska M, Gosk-Bierska I . Thromboembolism associated with atrial fibrillation as a cause of limb and organ ischemia. Adv Clin Exp Med. 2014; 22(6):865-73. View

January C, Samuel Wann L, Calkins H, Chen L, Cigarroa J, Cleveland Jr J . 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the.... Circulation. 2019; 140(2):e125-e151. DOI: 10.1161/CIR.0000000000000665. View

10.

Lopes R, Heizer G, Aronson R, Vora A, Massaro T, Mehran R . Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. N Engl J Med. 2019; 380(16):1509-1524. DOI: 10.1056/NEJMoa1817083. View

11.

Griffin W, Salahuddin T, ONeal W, Soliman E . Peripheral arterial disease is associated with an increased risk of atrial fibrillation in the elderly. Europace. 2015; 18(6):794-8. DOI: 10.1093/europace/euv369. View

12.

Imamura T, Kinugawa K . Novel rate control strategy with landiolol in patients with cardiac dysfunction and atrial fibrillation. ESC Heart Fail. 2020; 7(5):2208-2213. PMC: 7524084. DOI: 10.1002/ehf2.12879. View

13.

Shishehbor M, White C, Gray B, Menard M, Lookstein R, Rosenfield K . Critical Limb Ischemia: An Expert Statement. J Am Coll Cardiol. 2016; 68(18):2002-2015. DOI: 10.1016/j.jacc.2016.04.071. View

14.

Liu C, Chen K, Tseng C, Chang W, Wu Y, Hwang J . The dose-response effects of uric acid on the prevalence of metabolic syndrome and electrocardiographic left ventricular hypertrophy in healthy individuals. Nutr Metab Cardiovasc Dis. 2018; 29(1):30-38. DOI: 10.1016/j.numecd.2018.10.001. View

15.

ONeal W, Efird J, Nazarian S, Alonso A, Heckbert S, Soliman E . Peripheral arterial disease and risk of atrial fibrillation and stroke: the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. 2014; 3(6):e001270. PMC: 4338716. DOI: 10.1161/JAHA.114.001270. View

16.

Odutayo A, Wong C, Hsiao A, Hopewell S, Altman D, Emdin C . Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ. 2016; 354:i4482. DOI: 10.1136/bmj.i4482. View

17.

Gibson C, Mehran R, Bode C, Halperin J, Verheugt F, Wildgoose P . Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med. 2016; 375(25):2423-2434. DOI: 10.1056/NEJMoa1611594. View

18.

Lin Y, Tung T, Wang J, Chen Y, Chen T, Lin M . Peripheral arterial disease and atrial fibrillation and risk of stroke, heart failure hospitalization and cardiovascular death: A nationwide cohort study. Int J Cardiol. 2015; 203:204-11. DOI: 10.1016/j.ijcard.2015.10.091. View

19.

Winkel T, Hoeks S, Schouten O, Zeymer U, Limbourg T, Baumgartner I . Prognosis of atrial fibrillation in patients with symptomatic peripheral arterial disease: data from the REduction of Atherothrombosis for Continued Health (REACH) Registry. Eur J Vasc Endovasc Surg. 2010; 40(1):9-16. DOI: 10.1016/j.ejvs.2010.03.003. View

20.

Bekwelem W, Norby F, Agarwal S, Matsushita K, Coresh J, Alonso A . Association of Peripheral Artery Disease With Incident Atrial Fibrillation: The ARIC (Atherosclerosis Risk in Communities) Study. J Am Heart Assoc. 2018; 7(8). PMC: 6015443. DOI: 10.1161/JAHA.117.007452. View