Department of Cardiology, Hospital Universitario de San Juan de Alicante, Universidad Miguel Hernandez, Alicante, Spain.
Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares: CIBERCV, Madrid, Spain.
Eur J Clin Invest. 2021 Apr;51(4):e13431. doi: 10.1111/eci.13431. Epub 2020 Nov 2.
Atrial fibrillation (AF) and peripheral artery disease (PAD) are common conditions that increase cardiovascular risk. We determined the association between PAD and prognosis in a cohort of real-world patients receiving oral anticoagulant therapy for nonvalvular AF.
We prospectively included 1956 patients (mean age 73.8 ± 9.5 years, 44.0% women) receiving oral anticoagulant therapy for AF. Clinical characteristics were collected at baseline. Patients were followed for a period of 3 years. Survival analysis and multivariable regression analyses were performed to assess variables related to death, stroke, bleeding, myocardial infarction and major adverse cardiovascular events (MACE).
Patients with PAD (n = 118; 6%) exhibited higher rates of cardiovascular risk factors and cardiovascular diseases. After 3 years of follow-up, there were a total of 255 deaths (no PAD 233, vs PAD 22), 45 strokes (43 vs 2), 146 major bleedings (136 vs 10) and 168 MACE (148 vs 20). On univariate analysis, there was a higher risk of cardiovascular mortality (2.02%/year no PAD vs 4.08%/year PAD, P = .02), myocardial infarction (0.99%/year no PAD vs 2.43%/year PAD, P = .02) and MACE (3.18%/year no PAD vs 6.99%/year PAD, P < .01). There was no statistically significant association with these events after multivariable adjustment.
In a large cohort of anticoagulated patients with AF, the presence of PAD represents a higher risk subgroup and is associated with worse crude outcomes. The exact contribution of the PAD independently of other cardiovascular diseases or risk factors requires further investigation.
心房颤动（AF）和外周动脉疾病（PAD）是常见的增加心血管风险的疾病。我们在接受非瓣膜性 AF 口服抗凝治疗的真实世界患者队列中，确定了 PAD 与预后之间的关系。
我们前瞻性纳入了 1956 例（平均年龄 73.8 ± 9.5 岁，44.0%为女性）接受 AF 口服抗凝治疗的患者。在基线时收集临床特征。患者接受了 3 年的随访。进行生存分析和多变量回归分析，以评估与死亡、卒、出血、心肌梗死和主要不良心血管事件（MACE）相关的变量。
PAD 患者（n=118；6%）有更高的心血管危险因素和心血管疾病发生率。在 3 年的随访后，共有 255 例死亡（无 PAD 233 例，PAD 22 例）、45 例卒、146 例大出血（136 例，10 例）和 168 例 MACE（148 例，20 例）。单变量分析显示，心血管死亡率风险较高（无 PAD 为 2.02%/年，PAD 为 4.08%/年，P=0.02）、心肌梗死（无 PAD 为 0.99%/年，PAD 为 2.43%/年，P=0.02）和 MACE（无 PAD 为 3.18%/年，PAD 为 6.99%/年，P<0.01）。多变量调整后，这些事件与 PAD 无统计学关联。
在接受抗凝治疗的 AF 患者的大队列中，PAD 的存在代表了一个更高风险的亚组，与更差的粗结局相关。PAD 独立于其他心血管疾病或危险因素对预后的确切贡献需要进一步研究。
