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)
JournalAmerican Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2019

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Atrial Fibrillation
Extremities
Peripheral Arterial Disease
Odds Ratio
Confidence Intervals
Hospital Mortality
Amputation
Inpatients
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of In-Hospital Outcomes in Patients Having Limb-Revascularization With Versus Without Atrial Fibrillation. / Moussa Pacha, Homam; Al-khadra, Yasser; Darmoch, Fahed; Soud, Mohamad; Zaitoun, Anwar; Kwok, Chun Shing; Mamas, Mamas A.; Kaki, Amir; Garcia, Santiago; Banerjee, Subhash; Arain, Salman A.; Vetrovec, George W.; Glazier, James J.; Alraies, M. Chadi.

In: American Journal of Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Moussa Pacha, H, Al-khadra, Y, Darmoch, F, Soud, M, Zaitoun, A, Kwok, CS, Mamas, MA, Kaki, A, Garcia, S, Banerjee, S, Arain, SA, Vetrovec, GW, Glazier, JJ & Alraies, MC 2019, 'Comparison of In-Hospital Outcomes in Patients Having Limb-Revascularization With Versus Without Atrial Fibrillation', American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2019.07.069
Moussa Pacha, Homam ; Al-khadra, Yasser ; Darmoch, Fahed ; Soud, Mohamad ; Zaitoun, Anwar ; Kwok, Chun Shing ; Mamas, Mamas A. ; Kaki, Amir ; Garcia, Santiago ; Banerjee, Subhash ; Arain, Salman A. ; Vetrovec, George W. ; Glazier, James J. ; Alraies, M. Chadi. / Comparison of In-Hospital Outcomes in Patients Having Limb-Revascularization With Versus Without Atrial Fibrillation. In: American Journal of Cardiology. 2019.
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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.",
author = "{Moussa Pacha}, Homam and Yasser Al-khadra and Fahed Darmoch and Mohamad Soud and Anwar Zaitoun and Kwok, {Chun Shing} and Mamas, {Mamas A.} and Amir Kaki and Santiago Garcia and Subhash Banerjee and Arain, {Salman A.} and Vetrovec, {George W.} and Glazier, {James J.} and Alraies, {M. Chadi}",
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AU - Soud, Mohamad

AU - Zaitoun, Anwar

AU - Kwok, Chun Shing

AU - Mamas, Mamas A.

AU - Kaki, Amir

AU - Garcia, Santiago

AU - Banerjee, Subhash

AU - Arain, Salman A.

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