Influence of polyvascular disease on clinical outcome in patients undergoing transcatheter aortic valve implantation via transfemoral access.

BACKGROUND

The influence of polyvascular disease (PVD) on the short- and long-term clinical outcomes of patients undergoing transcatheter aortic valve implantation via trans-femoral access (TF-TAVI) has not been fully elucidated.

METHODS

A total of 2167 patients from the Optimized CathEter vAlvular iNtervention-TAVI (OCEAN-TAVI) registry who underwent TF-TAVI was studied. PVD was defined as the presence of at least two of the following vascular bed (VB) diseases: concomitant coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral artery disease (PAD).

RESULTS

Patients with PVD (288 patients, 13.3%) had a higher incidence of in-hospital complications, such as AKI (16.3% vs. 7.0%, p<0.01) and disabling stroke (3.5% vs. 1.2%, p<0.01) than patients without PVD. These complications caused higher rates of procedural mortality (4.5% vs. 2.0%, p<0.01). PVD increased the risk of the 2-year rate of cardiovascular death (adjusted hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.04-2.50; p<0.05); however, non-cardiovascular death, myocardial infarction, or ischemic stroke was not associated with PVD. Worsening heart failure (4.6% vs. 1.1%, p<0.01) was the main cause of cardiovascular death among patients with PVD. In a sub-analysis, compared with patients with AS alone, those with 2 VB diseases (CAD+PAD; adjusted HR, 1.93; 95% CI, 1.06-3.53; p<0.05) and 3 VB diseases (CAD+CVD+PAD; adjusted HR, 2.61; 95% CI, 1.21-5.62; p<0.05) had a higher risk of 2-year cardiovascular death.

CONCLUSIONS

The increased prevalence of concomitant atherosclerotic VB diseases before TF-TAVI may increase the rates of in-hospital complications and 2-year cardiovascular death. Given the higher rate of mortality in patients with PVD undergoing TF-TAVI, future studies focusing on medical therapy are needed to reduce long-term cardiovascular events in this high-risk subset.

Déclaration de conflit d'intérêts

: Dr. Yamamoto, Dr. Tada, Dr. Naganuma, Dr. Shirai, Dr. Mizutani, and Dr. Watanabe are clinical proctors for Edwards Lifesciences and Medtronic. Dr. Tabata, Dr. Takagi, and Dr. Hayashida are also clinical proctors of Edwards Lifesciences. Dr. Ueno is a clinical proctor for Medtronic. Dr. Mizutani, Dr Tabata, Dr Tada, Dr Takagi, Dr. Naganuma, Dr. Watanabe, Dr. Yamamoto, Dr. Shirai, and Dr. Hayashida receive speaker`s fee from Edwards Lifesciences. Dr. Mizutani, Dr. Yashima, Dr. Tabata, Dr. Takagi, Dr. Yamamoto, Dr. Shirai, and Dr. Hayashida also receive speaker`s fee from Daiichi-Sankyo company. Dr. Yamamoto, Dr. Shirai, Dr. Watanabe, Dr. Naganuma, Dr. Tada, Dr. Tabata, Dr. Mizutani, and Dr. Ueno receive speaker`s fee from Medtronic. Dr. Shirai, Dr. Takagi, Dr. Tabata, and Dr. Mizutani receive speaker`s fee from Abbott vascular. Dr. Tabata also receives speaker fee from Terumo, Asteras Amgen, Boston scientific, Century medical, and Livanova. Dr. Mizutani also receives speaker fee from Asteras Amgen, Boston scientific, and Sanofi. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The remaining authors have no conflicts of interests.