Prognosis of atrial fibrillation in patients with symptomatic peripheral arterial disease: data from the REduction of Atherothrombosis for Continued Health (REACH) Registry.
BACKGROUND
Atrial fibrillation (AF) is a significant risk factor for cardiovascular (CV) mortality. This study aims to evaluate the prognostic implication of AF in patients with peripheral arterial disease (PAD).


METHODS
The International Reduction of Atherothrombosis for Continued Health (REACH) Registry included 23,542 outpatients in Europe with established coronary artery disease, cerebrovascular disease (CVD), PAD and/or > or =3 risk factors. Of these, 3753 patients had symptomatic PAD. CV risk factors were determined at baseline. Study end point was a combination of cardiac death, non-fatal myocardial infarction (MI) and stroke (CV events) during 2 years of follow-up. Cox regression analysis adjusted for age, gender and other risk factors (i.e., congestive heart failure, coronary artery re-vascularisation, coronary artery bypass grafting (CABG), MI, hypertension, stroke, current smoking and diabetes) was used.


RESULTS
Of 3753 PAD patients, 392 (10%) were known to have AF. Patients with AF were older and had a higher prevalence of CVD, diabetes and hypertension. Long-term CV mortality occurred in 5.6% of patients with AF and in 1.6% of those without AF (p<0.001). Multivariable analyses showed that AF was an independent predictor of late CV events (hazard ratio (HR): 1.5; 95% confidence interval (CI): 1.09-2.0).


CONCLUSIONS
AF is common in European patients with symptomatic PAD and is independently associated with a worse 2-year CV outcome.
Winkel
T A
TA
Department of Vascular Surgery, Erasmus Medical Center, Room H 805, Erasmus MC, 's Gravendijkwal 230, 3015 GD Rotterdam, The Netherlands.
Hoeks
S E
SE
Schouten
O
O
Zeymer
U
U
Limbourg
T
T
Baumgartner
I
I
Bhatt
D L
DL
Steg
Ph G
PG
Goto
S
S
Röther
J
J
Cacoub
P P
PP
Verhagen
H J M
HJ
Bax
J J
JJ
Poldermans
D
D
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D016009:Chi-Square Distribution; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D010045:Outpatients; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors
D002317:Cardiovascular Agents