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

Homam Moussa Pacha, Yasser Al-khadra, Fahed Darmoch, Mohamad Soud, Anwar Zaitoun, Chun Shing Kwok, Mamas A. Mamas, Amir Kaki, Santiago Garcia, Subhash Banerjee, Salman A. Arain, George W. Vetrovec, James J. Glazier, M. Chadi Alraies

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1540-1548
Number of pages9
JournalAmerican Journal of Cardiology
Volume124
Issue number10
DOIs
StatePublished - Nov 15 2019

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Moussa Pacha, H., Al-khadra, Y., Darmoch, F., Soud, M., Zaitoun, A., Kwok, C. S., Mamas, M. A., Kaki, A., Garcia, S., Banerjee, S., Arain, S. A., Vetrovec, G. W., Glazier, J. J., & Alraies, M. C. (2019). Comparison of In-Hospital Outcomes in Patients Having Limb-Revascularization With Versus Without Atrial Fibrillation. American Journal of Cardiology, 124(10), 1540-1548. https://doi.org/10.1016/j.amjcard.2019.07.069