Atrial fibrillation and risk of cardiovascular events and mortality in patients with symptomatic peripheral artery disease: A meta‐analysis of prospective studies

Abstract

Background Atrial fibrillation (AF) is associated with adverse outcomes in terms of survival and morbidity. Peripheral artery disease (PAD) and AF share several common risk factors and often coexist. Whether AF has a prognostic role in patients with PAD has not been extensively studied. Hypothesis AF is associated with major adverse cardiac events (MACE) and mortality in symptomatic PAD patients. Methods Using MEDLINE and Scopus, we searched for studies published before December 2016 that evaluated cardiovascular outcomes based on the presence/absence of AF in a prospective manner with a follow‐up period of ≥12 months. The outcomes were reported using a random‐effects model, and heterogeneity was assessed using the I2 statistic. Sensitivity analyses were performed to test the contribution of each study to the overall results. Results Six prospective studies (Newcastle‐Ottawa score range, 7–9) with 14 656 patients were included in the final analysis (age range, 66–70 years; median follow‐up, 1.4 years). Our pooled analysis found a significant association between AF and mortality (odds ratio: 2.52, 95% confidence interval: 1.91‐3.34, I2 = 32.6%), without evidence of publication bias (P = 0.63). Meta‐analysis showed a significant impact of AF on MACE (odds ratio: 2.54, 95% confidence interval: 1.78‐3.63, I2 = 74.3%), without detected publication bias (P = 0.08). Conclusions AF is associated with increased risk of mortality and MACE in symptomatic PAD.

ACEF performed better than other risk scores in non-ST-elevation acute coronary syndrome during long term follow-up

“…Nevertheless, a modest improvement in accuracy of ACEF was obtained with the addition of female gender and atrial fibrillation in the computed model in this study (AUC 0.680). These findings are not surprising since atrial fibrillation is a well-established negative prognostic factor [33].…”

Four‐year incidence of major adverse cardiovascular events in patients with atherosclerosis and atrial fibrillation

“…Patients were also assessed for all‐cause mortality, stroke/systemic embolism at 1‐year of follow‐up, whereas our study retrospectively evaluated MACE using a cardiovascular death definition in an AF population comorbid with atherosclerotic disease over 4‐years of follow‐up. Similarly, meta‐analyses of PAD patients have found a significant association between AF and increased mortality (OR = 2.52, 95% CI = 1.91‐3.34) and diabetes and increased mortality (OR = 1.89, 95% CI = 1.51‐2.35) . The investigators also found the prevalence of AF among PAD patients to be 11.4%.…”

Chronic limb threatening ischemia and diabetes mellitus: the severity of tibial atherosclerosis and outcome after infrapopliteal revascularization

“…The number of endovascular (p = 0.096) and bypass procedures (p = 0.142) in the DM group remained stable during the follow-up. The median for the total revascularization treatments performed per year was 127 (IQr: 117-156), of which 80 (IQr: 77-110) was for endovascular and 43 (IQr: [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]) was for open bypasses. Table 2.…”