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Prognostic impact of atrial fibrillation on the outcomes of peripheral artery disease according to preoperative symptoms for endovascular revascularization

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Abstract

Peripheral artery disease (PAD) and atrial fibrillation (AF) are associated with major cardiovascular and cerebrovascular events (MACCE). However, outcomes stratified according to the preoperative symptoms of PAD in patients with AF have not been sufficiently investigated. This was a retrospective study of prospectively collected data pertaining to 2237 patients (1179 patients with intermittent claudication [IC] and 1058 patients with critical limb-threatening ischemia [CLTI]) who underwent endovascular therapy at 34 hospitals between August 2014 and August 2016. AF was present in 91 (7.7%) patients with IC and 150 (14.2%) patients with CLTI. In the CLTI group, patients with AF had a higher event rate of MACCE and all-cause death than those without AF (1-year rates of freedom from MACCE: 0.66 and 0.81 in patients with and without AF, respectively, p < 0.001). In contrast, in the IC group, there was no statistically significant difference in the rates of MACCE between patients with and without AF. In the Cox multivariate analysis, AF was a significant predictor of MACCE in patients with CLTI but not in patients with IC, even after adjusting for covariates. The impact of AF on the outcome of patients with PAD was greater in those with CLTI. Further studies are needed to clarify the possible mechanisms underlying these differences.

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Acknowledgements

The Vascular Disease Research Project of the Japan Research Promotion Society for Cardiovascular Diseases supported this work.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Shin-Yurigaoka General Hospital, Kanagawa, Japan

    Sadahiro Hijikata

  2. Department of Cardiovascular Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan

    Tetsuo Yamaguchi & Takahide Kodama

  3. Department of Cardiovascular Medicine, Kameda Medical Center, Chiba, Japan

    Daisuke Ueshima

  4. Department of Cardiology, Tokyo Medical and Dental University Hospital, Tokyo, Japan

    Tomoyuki Umemoto

  5. Department of Cardiology, St. Lukes International Hospital, Tokyo, Japan

    Atsushi Mizuno

  6. Department of Cardiology, Kasukabe Chuo General Hospital, Saitama, Japan

    Akihiro Matsui & Nobuhito Kaneko

  7. Department of Cardiology, Itabashi Chuo Medical Center, Tokyo, Japan

    Shunsuke Ozaki

  8. Department of Cardiology, Yamato Seiwa Hospital, Kanagawa, Japan

    Tatsuki Doijiri

  9. Department of Cardiology, Saitama Medical Center, Saitama, Japan

    Kentaro Jujo

  10. Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan

    Michiaki Higashitani

Authors
  1. Sadahiro Hijikata
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  2. Tetsuo Yamaguchi
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  8. Shunsuke Ozaki
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  10. Kentaro Jujo
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  11. Takahide Kodama
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  12. Michiaki Higashitani
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Corresponding author

Correspondence to Tetsuo Yamaguchi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board of Sakakibara Heart Institute (reference no. 14-023) and the committee of each participating facility. Written informed consent was obtained from all patients. The TOMA-CODE registry was registered at the University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR No. UMIN 000015100). This study was conducted in accordance with the Declaration of Helsinki and Japanese Ethical Guidelines for Medical and Health Research involving Human Subjects.

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Supplementary Information

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380_2022_2134_MOESM1_ESM.docx

Supplementary Table 1. Cause of deaths. Data are presented as numbers (%). CLTI, critical limb threatening ischemia. (DOCX 17 KB)

380_2022_2134_MOESM2_ESM.docx

Supplementary Table 2. Kaplan–Meier curves: event-free rate of each outcome. CLTI, critical limb threatening ischemia; IC, intermittent claudication. (DOCX 17 KB)

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Hijikata, S., Yamaguchi, T., Ueshima, D. et al. Prognostic impact of atrial fibrillation on the outcomes of peripheral artery disease according to preoperative symptoms for endovascular revascularization. Heart Vessels 38, 106–113 (2023). https://doi.org/10.1007/s00380-022-02134-8

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  • DOI: https://doi.org/10.1007/s00380-022-02134-8

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