Atrial fibrillation and risk of cardiovascular events and mortality in patients with symptomatic peripheral artery disease: A meta-analysis of prospective studies

Background: Atrial fibrillation (AF) is associated with adverse outcomes in terms of survival and morbidity. Peripheral artery disease (PAD) and AF share several common risk factors and often coexist. Whether AF has a prognostic role in patients with PAD has not been extensively studied. Hypothesis: AF is associated with major adverse cardiac events (MACE) and mortality in symptomatic PAD patients. Methods: Using MEDLINE and Scopus, we searched for studies published before December 2016 that evaluated cardiovascular outcomes based on the presence/absence of AF in a prospective manner with a follow-up period of >= 12 months. The outcomes were reported using a random-effects model, and heterogeneity was assessed using the I-2 statistic. Sensitivity analyses were performed to test the contribution of each study to the overall results. Results: Six prospective studies (Newcastle-Ottawa score range, 7-9) with 14 656 patients were included in the final analysis (age range, 66-70 years; median follow-up, 1.4 years). Our pooled analysis found a significant association between AF and mortality (odds ratio: 2.52, 95% confidence interval: 1.91-3.34, I-2 = 32.6%), without evidence of publication bias (P = 0.63). Meta-analysis showed a significant impact of AF on MACE (odds ratio: 2.54, 95% confidence interval: 1.78-3.63, I-2 = 74.3%), without detected publication bias (P = 0.08). Conclusions: AF is associated with increased risk of mortality and MACE in symptomatic PAD.