engleski

Atrial Fibrillation Predicts Cardiovascular Outcome in Hypertensive Patients With Symptomatic Peripheral Artery Disease and Preserved Ejection Fraction

Atrial fibrillation (AF) and peripheral artery disease (PAD) are prevalent in the aging population and share some common risk factors. We investigated the prognostic impact of AF on major adverse cardiovascular events (MACEs ; composite endpoint of acute myocardial infarction, urgent coronary revascularization, stroke, and death) in a cohort of consecutive mostly hypertensive patients with symptomatic PAD and preserved left ventricular ejection fraction (LVEF >50%). Between January 2010 and January 2014 we prospectively studied 319 patients (66% men, 87% hypertensive, mean age 70±10 years, ankle brachial index 0.59±0.14) with symptomatic PAD in Rutherford stages 3 (58%), 4 (24%), and 5 (18%). The diagnosis of PAD was established by clinical examination, ankle brachial index measurement, duplex sonography, and/or computed tomography or magnetic resonance angiography and confirmed with peripheral angiography using the criteria of the European Society of Cardiology. The prevalence of AF was 17.9% among PAD patients and was associated with unfavorable outcome. When compared with patients without AF, these patients were older (76 vs 69 years ; P<.001), with higher CHADS2 (congestive heart failure, hypertension, age 75 years, diabetes mellitus, stroke) scores (2.64 vs 1.99 ; P<.001) and more likely to have CLI (72% vs 35% ; P<.001), impaired renal function (61% vs 40% ; P=.006), and anemia (35% vs 18% ; P=.007). In logistic regression analysis, age (odds ratio, 1.09 ; 95% CI, 1.05–1.14 ; P<.001), and CLI (odds ratio, 3.62 ; 95% CI, 1.88–6.96 ; P<.001) were independently associated with AF. During the median follow-up period of 24 months (interquartile range, 16–34 months), 77 patients (24%) had a MACE. In the univariable analysis, AF, age, hypertension, CLI, anemia, history of cardiovascular disease, and decreased eGFR were significantly associated with MACEs. Multivariable Cox regression analysis revealed that only AF, renal impairment, and polyvascular disease independently predicted MACEs. Patients with AF, polyvascular disease, and impaired renal function at baseline were 11.23 times (95% CI, 3.15–40.03) more likely to experience MACEs than patients in sinus rhythm with single vascular disease and preserved renal function.

atrial fibrillation ; major adverse cardiovascular outcome ; peripheral artery disease

nije evidentirano