Atrial fibrillation worsens limb revascularization in PAD patients

Atrial fibrillation (AF) is tied to poorer outcomes in patients with peripheral artery disease (PAD) who undergo limb revascularization, a recent study has found.

Of 2,283,568 patients who underwent limb revascularization procedures from 2002 to 2014, 12.9 percent (n=294,469; mean age, 76.1±10.0 years; 45.6 percent female) had AF. Critical limb ischaemia (CLI) was more common among AF patients, while intermittent claudication (IC) was more prevalent in the non-AF group.

Multivariable logistic regression analysis found that AF increased the risk of in-hospital mortality among PAD patients undergoing surgical revascularization (6.4 percent vs 2.5 percent; adjusted odds ratio [OR], 1.09, 95 percent confidence intervals [CI], 1.05–1.12). The overall length of hospital stay was significantly longer than in non-AF counterparts (p<0.001).

Moreover, myocardial infarction (5.7 percent vs 3.0 percent; adjusted OR, 1.12, 95 percent CI, 1.09–1.16; p<0.001), postprocedural stroke (9.0 percent vs 6.2 percent; adjusted OR, 1.42, 95 percent CI, 1.37–1.48; p<0.001) and major bleeding (10.6 percent vs 6.2 percent; adjusted OR, 1.20, 95 percent CI, 1.18–1.23; p<0.001) all remained significantly more likely to occur in AF patients.

The same was true for major (19.1 percent vs 10.9 percent; adjusted OR, 1.22, 95 percent CI, 1.20–1.25; p<0.001) and net (28.9 percent vs 18.3 percent; adjusted OR, 1.22, 95 percent CI, 1.20–1.24; p<0.001) adverse cardiovascular events.

The effects of AF on worse outcomes remained consistent in patients who underwent endovascular interventions. Subgroup analysis according to those with IC or CLI likewise did not meaningfully change the principal findings.