Artikel
Impact of peripheral artery disease on in-hospital outcome in isolated transcatheter aortic valve replacement for severe aortic valve stenosis
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Autoren
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Nasser Malyar
- Universitätsklinikum Münster, Department für Kardiologie und Angiologie, Abteilung für Angiologie,, Münster, Deutschland
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Klaus Kaier
- Universitätsklinikum Freiburg, Klinische Epidemiologie, Department für Medizinische Biometrie und Medizinische Informatik, Freiburg, Deutschland
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Eva Freisinger
- Universitätsklinikum Münster, Abteilung für Angiologie, Department für Kardiologie und Angiologie, Münster, Deutschland
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Gerrit Kaleschke
- Universitätsklinikum Münster, Department für Kardiologie und Angiologie, Klinik für angeborene (EMAH) und erworbene Herzfehler, Münster, Deutschland
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Helmut Baumgartner
- Universitätsklinikum Münster, Department für Kardiologie und Angiologie, Klinik für angeborene (EMAH) und erworbene Herzfehler, Münster, Deutschland
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Holger Reinecke
- Universitätsklinikum Münster, Abteilung für Angiologie, Department für Kardiologie und Angiologie, Münster, Deutschland
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Jochen Reinöhl
- Universitäts-Herzzentrum Freiburg - Bad Krozingen, Kardiologie und Angiologie I, ISAH - Intervention bei strukturellen und angeborenen Herzkr, Freiburg, Deutschland
| Veröffentlicht: | 28. September 2016 |
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Gliederung
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Background: Peripheral artery disease (PAD) shares the risk factors with and is common in patients with severe aortic valve stenosis (AS) deemed for transcatheter aortic valve replacement (TAVR). Critical limb ischemia (CLI) is the most advanced stage of PAD associated with poor short and long term outcome. We aimed to elaborate the impact of stage-specific PAD on in-hospital outcome in patients undergoing TAVR in Germany.
Methods: All procedures of isolated TAVR in patients with the diagnosis of aortic valve stenosis performed in Germany between 2007 and 2013 were analyzed. Stage specific prevalence of PAD, of comorbidities, of periprocedural complications and mortality rate was obtained from diagnostic and procedural codes. The entire TAVR cohort was divided into 4 groups: without PAD (1), with PAD at non-critical limb ischemia (non-CLI) (2), those with PAD and CLI (3) and those with not otherwise specified atherosclerotic disease (4).
Results: Among the entire cohort of 32.581 TAVR patients, 3912 (12.0%) had the diagnosis of PAD, thereof 654 (2.0%) classified as CLI. Compared to non-PAD, TAVR patients with PAD were younger, more likely of male gender, had higher frequencies of concomitant comorbidities such as cardiac and extracardiac arteriopathy, pulmonary disease, renal and heart failure, atrial fibrillation and diabetes (P<0.001). PAD, particularly CLI, was associated with higher incidence of periprocedural stroke, bleeding and acute kidney injury (P<0.001). The overall in-hospital mortality for patients undergoing TAVR without PAD, non-CLI-PAD and CLI was 6.1%, 8.4% and 15%, respectively (P<0.001). In a multivariate logistic regression analysis adjusted for covariates including the logistic EuroSCORE, CLI was an independent predictor of in-hospital mortality (Odds ratio 1.98; 95% confidence interval 1.57-2.48; P<0.001, see Table 1 [Tab. 1]).
Conclusion and clinical implication: In this nationwide, real-world analysis of patients undergoing isolated TAVR in patients with the diagnosis of aortic valve stenosis PAD is associated with increased periprocedural risk and complications. Critical limb ischemia is an independent predictor of increased in-hospital mortality. Whether CLI represents a marker of general poor health status resulting in the poor outcome or a modifiable risk factor whose treatment prior to TAVI can improve the outcome requires prospective studies.
