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

Min-I Su1,2,3, Ying-Chih Cheng4,5, Yu-Chen Huang6,7,8

  • 1Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung 950, Taiwan.

Journal of Clinical Medicine
|April 12, 2022
PubMed

Insights

Atrial fibrillation (Afib) significantly increases mortality and major adverse cardiovascular events (MACEs) in patients with severe lower extremity arterial disease (LEAD). This finding highlights the importance of considering Afib in managing severe LEAD prognosis.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Clinical Outcomes Research

Background:

  • Atrial fibrillation (Afib) is known to be associated with lower extremity arterial disease (LEAD).
  • The prognostic impact of Afib on severe LEAD outcomes remains incompletely understood.
  • Severe LEAD poses significant risks for cardiovascular events and mortality.

Purpose of the Study:

  • To investigate the association between atrial fibrillation (Afib) and clinical outcomes in patients with severe lower extremity arterial disease (LEAD).
  • To determine if Afib independently predicts adverse events such as all-cause mortality and major adverse cardiovascular events (MACEs) in this patient population.

Main Methods:

  • Retrospective enrollment of consecutive severe LEAD patients undergoing percutaneous transluminal angioplasty from January 2013 to December 2018.
  • Patients were stratified based on the presence or absence of a history of Afib.
  • Follow-up for at least one year, with primary outcome of all-cause mortality and secondary outcomes including cardiac-related mortality and MACEs.

Main Results:

  • The study included 222 patients (74 ± 11 years, 54% male); 12.6% had acute limb ischemia.
  • The Afib group exhibited significantly higher rates of all-cause mortality (42.9% vs. 20.1%, p=0.014) and MACEs (32.1% vs. 14.4%, p=0.028) compared to the non-Afib group.
  • Afib was an independent predictor of all-cause mortality (adjusted HR: 2.153) and MACEs (adjusted HR: 2.338). Acute limb ischemia, Rutherford classification, and heart rate also independently predicted mortality.

Conclusions:

  • Atrial fibrillation is significantly associated with increased risks of one-year all-cause mortality and MACEs in patients with severe LEAD.
  • These findings underscore the critical prognostic role of Afib in severe arterial disease of the lower extremities.
  • Further research is warranted to explore the potential benefits of oral anticoagulants in managing Afib patients with severe LEAD.

Keywords:
atrial fibrillationlower extremity arterial diseasemortalitypercutaneous transluminal angioplasty

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