Association of peripheral artery disease with in-hospital outcomes after endovascular transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019 Aug 01;94(2):249-255
Date
04/27/2019Pubmed ID
31025488Pubmed Central ID
PMC6832693DOI
10.1002/ccd.28310Scopus ID
2-s2.0-85064956250 (requires institutional sign-in at Scopus site) 12 CitationsAbstract
OBJECTIVES: The aim of this study was to determine the prevalence of peripheral artery disease (PAD) and its association with in-hospital outcomes after endovascular transcatheter aortic valve replacement (EV-TAVR).
BACKGROUND: TAVR is an established treatment for patients at prohibitive, high, or intermediate surgical risk. PAD is a significant comorbidity in the determination of surgical risk. However, data on association of PAD with outcomes after EV-TAVR are limited.
METHODS: Patients in the National Inpatient Sample who underwent EV-TAVR between January 1, 2012 and September 30, 2015 were evaluated. The primary outcome was in-hospital mortality.
RESULTS: A total of 51,685 patients underwent EV-TAVR during the study period. Of these, 12,740 (24.6%) had a coexisting diagnosis of PAD. The adjusted odds for in-hospital mortality [OR 1.08 (95% CI 0.83-1.41)], permanent pacemaker implantation [OR 0.98 (0.85-1.14)], conversion to open aortic valve replacement [OR 1.05 (0.49-2.26)], or acute myocardial infarction [OR 1.31(0.99-1.71)] were not different in patients with versus without PAD. However, patients with PAD had greater adjusted odds of vascular complications [OR 1.80 (1.50-2.16)], major bleeding [OR 1.20 (1.09-1.34)], acute kidney injury (AKI) [OR 1.19 (1.05-1.36)], cardiac complications [aOR 1.21 (1.01-1.44)], and stroke [OR 1.39(1.10-1.75)] compared with patients without PAD. Length of stay (LOS) was significantly longer for patients with PAD [7.23 (0.14) days vs. 7.11 (0.1) days, p < 0.001].
CONCLUSION: Of patients undergoing EV-TAVR, ~25% have coexisting PAD. PAD was not associated with increased risk of in-hospital mortality but was associated with higher risk of vascular complications, major bleeding, AKI, stroke, cardiac complications, and longer LOS.
Author List
Mohananey D, Villablanca P, Gupta T, Ranka S, Bhatia N, Adegbala O, Ando T, Wang DD, Wiley JM, Eng M, Kalra A, Ramakrishna H, Shah B, O'Neill W, Saucedo J, Bhatt DLAuthor
Divyanshu Mohananey MD Assistant Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Aged, 80 and overAortic Valve
Aortic Valve Stenosis
Databases, Factual
Female
Hospital Mortality
Humans
Inpatients
Male
Peripheral Arterial Disease
Postoperative Complications
Prevalence
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
United States
