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Atrial fibrillation and risk of cardiovascular events andmortality in patients with symptomatic peripheral arterydisease: A meta-analysis of prospective studies

Background: Atrial fibrillation (AF) is associated with adverse outcomes in terms of survival andmorbidity. Peripheral artery disease (PAD) and AF share several common risk factors and oftencoexist. Whether AF has a prognostic role in patients with PAD has not been extensivelystudied.Hypothesis: AF is associated with major adverse cardiac events (MACE) and mortality in symp-tomatic PAD patients.Methods: Using MEDLINE and Scopus, we searched for studies published before December2016 that evaluated cardiovascular outcomes based on the presence/absence of AF in a pro-spective manner with a follow-up period of ≥12 months. The outcomes were reported using arandom-effects model, and heterogeneity was assessed using the I2statistic. Sensitivity ana-lyses 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 patientswere included in the final analysis (age range, 66–70 years ; median follow-up, 1.4 years). Ourpooled 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.

atrial fibrillation ; cardiovascular events ; meta-analysis ; mortality ; peripheral artery disease

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