engleski

Atrial fibrillation and impaired renal function predict cardiovascular outcome in mostly hypertensive patients with symptomatic peripheral artery disease and preserved ejection fraction

Purpose: The study investigated the prognostic role of atrial fibrillation (AF) and renal function in patients (pts) with symptomatic peripheral artery disease (PAD) and preserved left ventricular ejection fraction (LVEF). Methods: The occurrence of major adverse cardiovascular events (MACE, composite endpoint of death, myocardial infarction, stroke, percutaneous coronary intervention and coronary bypass surgery) was prospectively assessed in 183 PAD pts, Fontaine stages IIb and III, LVEF>50% (66% males, 86% hypertensive, mean age 69.7 years, mean ABI 0.59). The diagnosis of AF was based on history and electrocardiographic evidence of arrhythmia. Multivariate Cox regression analysis adjusted for age, gender, traditional cardiovascular risk factors, critical limb ischemia (CLI), estimated glomerular filtration rate (eGFR), AF, coronary and cerebrovascular disease and medications used was applied to assess the independent predictors of poor clinical outcome. Results: The prevalence of AF was 15.3% among PAD pts. During the median follow-up period of 24 months, 42 pts (23%) had an event. These pts were older (72 vs 69 years ; p=0.03), more likely to have AF (29% vs 11% ; p=0.013), CLI (50% vs 28% ; p=0.015), history of coronary and cerebrovascular disease (52% vs 37% ; p=0.07) and worse renal function (eGFR<60 ml/min, 62% vs 41% ; p=0.028). After multivariable adjustment, AF (HR=2.1, 95% CI=1.07-4.10 ; p=0.03) and eGFR<60 ml/min (HR=1.97, 95% CI=1.05-3.68 ; p=0.035) remained the only independent predictors of unfavorable outcome (Figure). The model that incorporated AF and renal function to ABI tended to improve prediction of MACE (AUC increased from 0.60 to 0.68 ; p=0.07). Conclusion: Impaired renal function and AF are strong and independent predictors of MACE in symptomatic PAD pts with preserved LVEF.

atrial fibrillation ; hypertension ; peripheral artery disease

nije evidentirano