Impact of Atrial Fibrillation on Prognosis of Infrapopliteal Arterial Disease in Patients Post-EVT: A Retrospective Analysis

Background: Atrial fibrillation and lower limb arterial disease present comparable risks and have a mutually exacerbating effect. However, the prognostic influence of atrial fibrillation on lower limb arterial lesions, particularly those susceptible to embolism and infrapopliteal lesions, remains uncertain. METHODS In this single-center retrospective study conducted from January 2014 to December 2021, patients who underwent endovascular therapy (EVT) for infrapopliteal arterial lesions were classified based on the presence of atrial fibrillation and followed up for at least a year. For the comparative analysis of outcome events, We calculated person-years incidence rates, derived HR values, determined 95% CI via Poisson regression, and tested significance with Cox regression. The primary endpoint involved limb-related adverse events, while secondary outcomes incorporated cardio-cerebrovascular events and all-cause death. Results This study involved 176 patients (59 women, 117 men; median age 76, IQR 68–81; range 52–93 years), including 84 with atrial fibrillation (AF) and 92 without. The AF group had higher incidence of limb-related events (70.2% vs 59.8%, P = 0.027), combined limb and cardio-cerebral vascular outcomes (76.2% vs 65.2%, P = 0.001), and cardio-cerebral vascular events alone (31.0% vs 15.2%, P = 0.001). AF was independently associated with adverse limb (Adjusted HR 1.729, 95% CI 1.155–2.588) and cardio-cerebral vascular outcomes (Adjusted HR 2.338, 95% CI 1.202–4.550) in infrapopliteal arterial lesion patients. Conclusion Atrial fibrillation independently predicts both cardio-cerebral vascular and limb adverse outcomes post-EVT in patients with infrapopliteal arterial occlusions. For these patients, monitoring should extend beyond cardio-cerebral vasculature to include limb blood supply and vascular conditions.