Comparison of In-Hospital Outcomes in Patients Having Limb-Revascularization With Versus Without Atrial Fibrillation

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Epidemiology

Background:

• Peripheral artery disease (PAD) affects millions, with limb revascularization as a key treatment.
• Atrial fibrillation (AF) is a common comorbidity, but its impact on PAD revascularization outcomes is unclear.
• Understanding AF's role is crucial for optimizing patient care and outcomes.

Purpose of the Study:

• To compare in-hospital outcomes for patients with and without AF undergoing limb revascularization.
• To investigate the association between AF and adverse events like mortality and major amputation.
• To analyze trends in endovascular intervention (EVI) versus surgical revascularization in PAD patients with and without AF.

Main Methods:

• Retrospective analysis of the National Inpatient Sample (2002-2014).
• Inclusion of patients aged ≥18 with PAD undergoing limb revascularization (surgical or EVI).
• Multivariate logistic regression to assess in-hospital outcomes, adjusting for confounders.

Main Results:

• Over 2.2 million limb revascularizations were performed; 12.9% of patients had AF.
• AF patients were older, more likely women and white.
• AF was associated with increased in-hospital mortality and major amputation for both surgical (aOR 1.09, 1.05) and EVI (aOR 1.29, 1.07) procedures.
• EVI utilization increased, while surgical revascularization decreased over time for all patients.

Conclusions:

• Atrial fibrillation is linked to significantly worse in-hospital outcomes, including mortality and major amputation, following limb revascularization in PAD patients.
• Both surgical and endovascular revascularization approaches show increased risk in AF patients.
• These findings highlight the need for careful management of AF in PAD patients undergoing revascularization.