Su Min-I, Cheng Ying-Chih, Huang Yu-Chen, Liu Cheng-Wei
Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung 950, Taiwan.
MacKay Medical College, New Taipei City 252, Taiwan.
J Clin Med. 2022 Mar 31;11(7):1936. doi: 10.3390/jcm11071936.
Atrial fibrillation (Afib) is associated with the presence of lower extremity arterial disease (LEAD), but its effect on a severe LEAD prognosis remains unclear. We investigated the association between Afib and clinical outcomes. We retrospectively enrolled consecutive severe LEAD patients undergoing percutaneous transluminal angioplasty between 1 January 2013 and 31 December 2018. Patients were divided according to the history of any type of Afib and followed for at least one year. The primary outcome was all-cause mortality. Secondary outcomes were cardiac-related mortality and major adverse cardiovascular events (MACEs). The study included 222 patients aged 74 ± 11 years (54% male), and 12.6% had acute limb ischemia. The Afib group had significantly higher rates of all-cause mortality (42.9% vs. 20.1%, = 0.014) and MACEs (32.1% vs. 14.4%, = 0.028) than the non-Afib group. Afib was independently associated with all-cause mortality (adjusted HR: 2.153, 95% CI: 1.084-4.276, = 0.029) and MACEs (adjusted HR: 2.338, 95% CI: 1.054-2.188, = 0.037). The other factors associated with all-cause mortality included acute limb ischemia (adjusted HR: 2.898, 95% CI: 1.504-5.586, = 0.001), Rutherford classification, and heart rate. Afib was significantly associated with increased risks of one-year all-cause mortality and MACEs in patients with severe LEAD. Future studies should investigate whether oral anticoagulants benefit these patients.
心房颤动（房颤）与下肢动脉疾病（LEAD）的存在有关，但其对严重LEAD预后的影响尚不清楚。我们研究了房颤与临床结局之间的关联。我们回顾性纳入了2013年1月1日至2018年12月31日期间连续接受经皮腔内血管成形术的严重LEAD患者。根据是否有任何类型房颤病史对患者进行分组，并随访至少一年。主要结局是全因死亡率。次要结局是心脏相关死亡率和主要不良心血管事件（MACE）。该研究纳入了222名年龄为74±11岁的患者（54%为男性），12.6%有急性肢体缺血。房颤组的全因死亡率（42.9%对20.1%，P = 0.014）和MACE发生率（32.1%对14.4%，P = 0.028）显著高于非房颤组。房颤与全因死亡率（校正后HR：2.153，95%CI：1.084 - 4.276，P = 0.029）和MACE（校正后HR：2.338，95%CI：1.054 - 2.188，P = 0.037）独立相关。与全因死亡率相关的其他因素包括急性肢体缺血（校正后HR：2.898，95%CI：1.504 - 5.586，P = 0.001）、卢瑟福分类和心率。房颤与严重LEAD患者一年全因死亡率和MACE风险增加显著相关。未来的研究应调查口服抗凝剂是否对这些患者有益。
