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Comparison of In-Hospital Outcomes in Patients Having Limb-Revascularization With Versus Without Atrial Fibrillation

      The impact of atrial fibrillation (AF) on clinical outcomes among patients with peripheral artery disease (PAD) who undergo limb revascularization procedures is not well understood. We aim to compare in-hospital outcomes for patients with and without AF who underwent limb revascularization. We identified patients with PAD aged ≥18 years that underwent limb revascularization using endovascular or surgical approaches in the National Inpatient Sample between 2002 and 2014. Multivariate logistic regression analysis was performed to examine in-hospital outcomes. A total of 2,283,568 patients underwent limb revascularization during the study duration and 294,469 (12.9%) had AF. Patients with AF were older (mean age 76.1 ± 10.0 years), more likely to be women and white, compared with non-AF group. Among patients who had surgical revascularization, AF was associated with a higher rates of in-hospital mortality (6.4% vs 2.5%, adjusted odds ratio [aOR]: 1.09 [95% confidence interval {CI}: 1.05 to 1.12]) and major amputation (5.2% vs 3.8%, aOR: 1.05 [95% CI: 1.02 to 1.08]), compared with non-AF group. Among patients who had endovascular intervention (EVI), AF was associated with a higher rates of in-hospital mortality (3.8% vs 1.6%, aOR: 1.29 [95% CI: 1.24 to 1.33]) and major amputation (5.2% vs 3.9%, aOR: 1.07 [95% CI: 1.04 to 1.10]), compared with non-AF group. Within study period, EVI utilization increased in patients with and without AF (Ptrend <0.001); whereas, surgical revascularization utilization decreased in patients with and without AF (Ptrend <0.001). In conclusion, among patients with PAD who undergo limb revascularization, AF appears to be associated with poor in-hospital outcomes.
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      References

        • Kalbaugh CA
        • Kucharska-Newton A
        • Wruck L
        • Lund JL
        • Selvin E
        • Matsushita K
        • Bengtson LGS
        • Heiss G
        • Loehr L
        Peripheral artery disease prevalence and incidence estimated from both outpatient and inpatient settings among Medicare fee-for-service beneficiaries in the Atherosclerosis Risk in Communities (ARIC) Study.
        J Am Heart Assoc. 2017; 6: 1-9
        • Fowkes FG
        • Rudan D
        • Rudan I
        • Aboyans V
        • Denenberg JO
        • McDermott MM
        • Norman PE
        • Sampson UK
        • Williams LJ
        • Mensah GA
        • Criqui MH
        Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis.
        Lancet. 2013; 382: 1329-1340
        • Violi F
        • Davi G
        • Hiatt W
        • Lip GY
        • Corazza GR
        • Perticone F
        • Proietti M
        • Pignatelli P
        • Vestri AR
        • Basili S
        • Investigators AS
        Prevalence of peripheral artery disease by abnormal ankle-brachial index in atrial fibrillation: implications for risk and therapy.
        J Am Coll Cardiol. 2013; 62: 2255-2256
        • Aboyans V
        • Ricco JB
        • Bartelink MEL
        • Bjorck M
        • Brodmann M
        • Cohnert T
        • Collet JP
        • Czerny M
        • De Carlo M
        • Debus S
        • Espinola-Klein C
        • Kahan T
        • Kownator S
        • Mazzolai L
        • Naylor AR
        • Roffi M
        • Rother J
        • Sprynger M
        • Tendera M
        • Tepe G
        • Venermo M
        • Vlachopoulos C
        • Desormais I
        • Group ESCSD
        2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS).
        Eur Heart J. 2018; 39: 763-816
        • Violi F
        • Lip GY
        • Basili S
        Peripheral artery disease and atrial fibrillation: a potentially dangerous combination.
        Intern Emerg Med. 2012; 7: 213-218
        • Winkel TA
        • Hoeks SE
        • Schouten O
        • Zeymer U
        • Limbourg T
        • Baumgartner I
        • Bhatt DL
        • Steg PG
        • Goto S
        • Rother J
        • Cacoub PP
        • Verhagen HJ
        • Bax JJ
        • Poldermans D
        Prognosis of atrial fibrillation in patients with symptomatic peripheral arterial disease: data from the REduction of Atherothrombosis for Continued Health (REACH) Registry.
        Eur J Vasc Endovasc Surg. 2010; 40: 9-16
        • Wasmer K
        • Unrath M
        • Kobe J
        • Malyar NM
        • Freisinger E
        • Meyborg M
        • Breithardt G
        • Eckardt L
        • Reinecke H
        Atrial fibrillation is a risk marker for worse in-hospital and long-term outcome in patients with peripheral artery disease.
        Int J Cardiol. 2015; 199: 223-228
        • Olesen JB
        • Lip GY
        • Lane DA
        • Kober L
        • Hansen ML
        • Karasoy D
        • Hansen CM
        • Gislason GH
        • Torp-Pedersen C
        Vascular disease and stroke risk in atrial fibrillation: a nationwide cohort study.
        Am J Med. 2012; 125 (826 e813-823)
      1. Overview of the National (Nationwide) Inpatient Sample (NIS). Available at: https://www.hcup-us.ahrq.gov/nisoverview.jsp.

        • Kullo IJ
        • Rooke TW
        Clinical practice. Peripheral Artery Disease.
        N Engl J Med. 2016; 374: 861-871
        • Agarwal S
        • Sud K
        • Shishehbor MH
        Nationwide trends of hospital admission and outcomes among critical limb ischemia patients: from 2003-2011.
        J Am Coll Cardiol. 2016; 67: 1901-1913
        • Elixhauser A
        • Steiner C
        • Harris DR
        • Coffey RM
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27
        • Violi F
        • Davi G
        • Proietti M
        • Pastori D
        • Hiatt WR
        • Corazza GR
        • Perticone F
        • Pignatelli P
        • Farcomeni A
        • Vestri AR
        • Lip GY
        • Basili S
        • Investigators AS
        Ankle-brachial index and cardiovascular events in atrial fibrillation. The ARAPACIS Study.
        Thromb Haemost. 2016; 115: 856-863
        • Proietti M
        • Raparelli V
        • Laroche C
        • Dan GA
        • Janion M
        • Popescu R
        • Sinagra G
        • Vijgen J
        • Boriani G
        • Maggioni AP
        • Tavazzi L
        • Lip GYH
        • Investigators E-AGP
        Adverse outcomes in patients with atrial fibrillation and peripheral arterial disease: a report from the EURObservational research programme pilot survey on atrial fibrillation.
        Europace. 2017; 19: 1439-1448
        • Goto S
        • Bhatt DL
        • Rother J
        • Alberts M
        • Hill MD
        • Ikeda Y
        • Uchiyama S
        • D'Agostino R
        • Ohman EM
        • Liau CS
        • Hirsch AT
        • Mas JL
        • Wilson PW
        • Corbalan R
        • Aichner F
        • Steg PG
        • Investigators RR
        Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis.
        Am Heart J. 2008; 156 (863 e852): 855-863
        • Conway DS
        • Lip GY.
        Comparison of outcomes of patients with symptomatic peripheral artery disease with and without atrial fibrillation (the West Birmingham Atrial Fibrillation Project).
        Am J Cardiol. 2004; 93 (A1410): 1422-1425
        • Benjamin EJ
        • Blaha MJ
        • Chiuve SE
        • Cushman M
        • Das SR
        • Deo R
        • de Ferranti SD
        • Floyd J
        • Fornage M
        • Gillespie C
        • Isasi CR
        • Jimenez MC
        • Jordan LC
        • Judd SE
        • Lackland D
        • Lichtman JH
        • Lisabeth L
        • Liu S
        • Longenecker CT
        • Mackey RH
        • Matsushita K
        • Mozaffarian D
        • Mussolino ME
        • Nasir K
        • Neumar RW
        • Palaniappan L
        • Pandey DK
        • Thiagarajan RR
        • Reeves MJ
        • Ritchey M
        • Rodriguez CJ
        • Roth GA
        • Rosamond WD
        • Sasson C
        • Towfighi A
        • Tsao CW
        • Turner MB
        • Virani SS
        • Voeks JH
        • Willey JZ
        • Wilkins JT
        • Wu JH
        • Alger HM
        • Wong SS
        • Muntner P
        • American Heart Association Statistics C
        • Stroke Statistics S
        Heart disease and stroke statistics-2017 update: a report from the American Heart Association.
        Circulation. 2017; 135: e146-e603
        • Frost L
        • Engholm G
        • Johnsen S
        • Moller H
        • Henneberg EW
        • Husted S
        Incident thromboembolism in the aorta and the renal, mesenteric, pelvic, and extremity arteries after discharge from the hospital with a diagnosis of atrial fibrillation.
        Arch Intern Med. 2001; 161: 272-276
        • Watson T
        • Shantsila E
        • Lip GY
        Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited.
        Lancet. 2009; 373: 155-166
        • Griffin WF
        • Salahuddin T
        • O'Neal WT
        • Soliman EZ
        Peripheral arterial disease is associated with an increased risk of atrial fibrillation in the elderly.
        Europace. 2016; 18: 794-798
        • Jones WS
        • Hellkamp AS
        • Halperin J
        • Piccini JP
        • Breithardt G
        • Singer DE
        • Fox KA
        • Hankey GJ
        • Mahaffey KW
        • Califf RM
        • Patel MR
        Efficacy and safety of rivaroxaban compared with warfarin in patients with peripheral artery disease and non-valvular atrial fibrillation: insights from ROCKET AF.
        Eur Heart J. 2014; 35: 242-249
        • Sullivan TM
        • Taylor SM
        • Blackhurst DW
        • Langan 3rd, EM
        • Cull DL
        • Carsten 3rd, CG
        • Gray BH
        • Snyder BA
        • Youkey JR
        Has endovascular surgery reduced the number of open vascular operations performed by an established surgical practice?.
        J Vasc Surg. 2002; 36: 514-519
        • Malyar N
        • Furstenberg T
        • Wellmann J
        • Meyborg M
        • Luders F
        • Gebauer K
        • Bunzemeier H
        • Roeder N
        • Reinecke H
        Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis.
        Eur Heart J. 2013; 34: 2706-2714
        • Sachs T
        • Pomposelli F
        • Hamdan A
        • Wyers M
        • Schermerhorn M
        Trends in the national outcomes and costs for claudication and limb threatening ischemia: angioplasty vs bypass graft.
        J Vasc Surg. 2011; 54 (e1021): 1021-1031