Relationship of peripheral and coronary artery disease to cardiovascular events in patients with atrial fibrillation

BACKGROUND: To investigate the impact of concomitant asymptomatic peripheral artery disease (PAD) and pre-existing coronary artery disease (CAD) on cardiovascular events (CVEs) in atrial fibrillation (AF) patients. METHODS: Prospective multicenter study including 1138 anticoagulated AF patients. PAD was diagnosed by can ankle-brachial index (ABI)≤0.9, and CAD as a documented myocardial infarction (MI) or cardiac revascularization. The cohort was divided into 4 groups: group 0 (n=717) with no previous CAD and ABI >0.9; group 1 (n=168) no previous CAD and ABI≤0.9; group 2 (n=183) previous CAD and ABI >0.9: and group 3 (n=70) previous CAD and ABI≤0.9. The primary endpoint was a composite of CVEs. RESULTS: Mean age was 72.6years and 41.3% were female. History of CAD was present in 253 (22.2%) patients, and 238 (20.9%) had an ABI≤0.9. Patients with previous CAD were more likely to have a low ABI compared to those without (OR:1.6, 95%CI 1.2-2.3, P=0.003). Median follow-up was 35.9months (IQR 19.2-57.2, 3819 patient-years), and 145 CVEs were recorded (3.8%/year 95%CI 3.2-4.5). Survival analysis showed a progressive increase in the rate of CVEs in the four groups (log-rank test P<0.001). Multivariable Cox regression analysis showed that as compared to group 0, group 1 (HR:1.8, 95%CI 1.1-2.9, P=0.01), group 2 (HR:2.2, 95%CI 1.4-3.4, P=0.001) and group 3 (HR:2.4, 95%CI 1.4-4.4, P=0.003) were associated with progressive greater risk of CVEs. CONCLUSION: Patients with concomitant CAD and asymptomatic PAD are at high risk of CVEs, with a progressive risk with vascular disease burden where PAD was associated with CAD.