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Meta-Analysis
. 2021 Aug;44(8):1050-1057.
doi: 10.1002/clc.23678. Epub 2021 Jun 25.

Peripheral artery disease and clinical outcomes in patients with atrial fibrillation: A systematic review and meta-analysis

Jianfu Zhu  1 , Xiaowei Tan  1 , Jian Zhong Zhou  1
Affiliations
Meta-Analysis

Peripheral artery disease and clinical outcomes in patients with atrial fibrillation: A systematic review and meta-analysis

Jianfu Zhu et al. Clin Cardiol. 2021 Aug.

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac rhythm disturbance and leads to morbidity and mortality. Peripheral artery disease (PAD) is associated with atherosclerotic risk factors and always classified as a vascular disease and deemed to be a bad complication of AF. In patients with AF, the risk and prognostic value of PAD have not been estimated comprehensively.

Hypothesis: PAD is associated with all-cause mortality, cardiovascular (CV) mortality, and other outcomes in patients with AF.

Methods: We searched PubMed, Embase, and Cochrane Library databases for prospective studies published before April 2021 that provided outcomes data on PAD in confirmed patients with AF. Heterogeneity was estimated using the I2 statistic. The fixed-effects model was used for low to moderate heterogeneity studies, and the random-effects model was used for high heterogeneity studies.

Results: Eight prospective studies (Newcastle-Ottawa score range, 7-8) with 39 654 patients were enrolled. We found a significant association between PAD and all-cause mortality (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.25-1.62; p < .001), CV mortality (HR, 1.64; 95% CI, 1.32-2.05; p < .001) and MACE (HR, 1.75; 95% CI, 1.38-2.22; p < .001) in patients with AF. No significant relationship was found in major bleeding (HR, 1.22; 95% CI, 0.95-1.57; p = 0.118), myocardial infarction (MI) (HR, 2.07; 95% CI, 1.17-3.67; p = .038), and stroke (HR, 1.14; 95% CI, 0.87-1.50, p = 0.351).

Conclusions: PAD is associated with an increased risk of all-cause mortality, CV mortality, and MACE in patients with AF. However, no significant association was found with major bleeding, MI, and stroke.

Keywords: atrial fibrillation; cardiovascular events; major bleeding; meta-analysis; mortality; outcome; peripheral artery disease; stroke.

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Figures

FIGURE 1
FIGURE 1
Flow diagram
FIGURE 2
FIGURE 2
The association between PAD and all‐cause mortality. ES, effect size
See this image and copyright information in PMC

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References

    1. Nattel S. New ideas about atrial fibrillation 50 years on. Nature. 2002;415(6868):219‐226. - PubMed
    1. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation. 2014;129(8):837‐847. - PMC - PubMed
    1. Rahman F, Kwan GF, Benjamin EJ. Global epidemiology of atrial fibrillation. Nat Rev Cardiol. 2014;11(11):639‐654. - PubMed
    1. Hart RG, Halperin JL. Atrial fibrillation and stroke: concepts and controversies. Stroke. 2001;32(3):803‐808. - PubMed
    1. Ruff CT, Bhatt DL, Steg PG, et al. REACH registry investigators. Long‐term cardiovascular outcomes in patients with atrial fibrillation and atherothrombosis in the REACH registry. Int J Cardiol. 2014;170(3):413‐418. - PubMed