Thromboembolic events in atrial fibrillation: Different level of risk and pattern between peripheral artery disease and coronary artery disease

Yu-Sheng Lin (1) , Victor Chien-Chia Wu , Yung-Lung Chen , Chi-Hung Liu , Huang-Chung Chen , Wei-Chieh Lee , Teng-Yao Yang , Victor Aboyans (2, 3) , Mien-Cheg Chen

1 Chang Gung Memorial Hospital [Taoyuan, Taiwan]
2 NET - Neuroépidémiologie Tropicale
3 Service de cardiologie [CHU Limoges]

Background. — The existence of vascular disease in patients with atrial fibrillation (AF) is associated with an increased risk of thromboembolic events. It is unclear whether coronary arterydisease (CAD) and/or peripheral artery disease (PAD) have similar presentations and complica-tion rates.Aim. — To investigate thromboembolic events among patients with AF who have CAD, PAD orpolyvascular disease.Methods. — Patients with a new diagnosis of AF without anticoagulation (n = 306,386) were iden-tified from the National Health Insurance Research Database in Taiwan (2001—2013). Ischaemicstroke (IS), systemic thromboembolism (STE) and their combination (IS/STE) were compared infour groups (No-CAD/PAD, CAD-only, PAD-only, CAD + PAD), and secondarily in patients with onlyCAD versus only PAD. Last, we compared propensity score-matched patients with only CAD orPAD with those with CAD and PAD.Results. — There were 185,169 patients without CAD or PAD, 8113 patients with only PAD,105,715 patients with only CAD, and 7389 patients with CAD and PAD eligible for analysis(mean ± SD follow-up 3.2 ± 3.2 years). The incidences of STE and IS/STE differed in the fourgroups, with the highest in the CAD + PAD group and the lowest in the No-CAD/PAD group. Theproportions of IS and STE also varied, with higher proportions of STE in patients with PAD, buthigher proportions of IS in patients with CAD. After propensity score matching, the PAD-onlygroup had significantly higher incidences of STE and IS/STE than the CAD-only group, across alllevels of CHA2DS2-VASc score. Patients with CAD and PAD had a significantly higher incidence ofSTE and IS/STE than propensity score-matched patients with CAD or PAD.Conclusions. — PAD or CAD in patients with AF did not contribute equally to the risk predictionand presentation of IS and STE. Patients with polyvascular disease should be considered athigher risk than those with either condition.

Mots clés: Peripheral artery disease; Coronary artery disease; Atrial fibrillation; Ischaemic stroke; Systemic; thromboembolism

Domaines: Santé publique et épidémiologie

Yu-Sheng Lin, Victor Chien-Chia Wu, Yung-Lung Chen, Chi-Hung Liu, Huang-Chung Chen, et al.. Thromboembolic events in atrial fibrillation: Different level of risk and pattern between peripheral artery disease and coronary artery disease. Archives of cardiovascular diseases, 2021, ⟨10.1016/j.acvd.2020.11.004⟩. ⟨hal-03124893⟩