Author + information
- Alexander C. Fanaroff,
- Pratik Manandhar,
- David Holmes,
- David Cohen,
- J. Kevin Harrison,
- G. Chad Hughes,
- Vinod Thourani,
- Michael Mack,
- William Jones and
- Sreekanth Vemulapalli
Background: Peripheral artery disease (PAD) is associated with increased cardiovascular mortality, and PAD risk factors overlap with those for aortic stenosis (AS). The prevalence and outcomes of PAD in a population undergoing commercial transcatheter aortic valve replacement (TAVR) has not been described.
Methods: Using the STS/TVT Registry linked to Medicare claims, we identified patients > 65 years old undergoing TAVR for AS via transfemoral (TF) access between November 2011 and September 2015 who had 1-year follow-up data. We calculated hazard ratios (HR) for all-cause death, MI, and bleeding for patients with PAD compared with those without, adjusting for baseline characteristics and post-procedure medications.
Results: Of 20,012 patients undergoing TF TAVR at 389 sites, 4907 (20.4%) had PAD and 15,105 did not. Compared to patients without PAD, those with PAD were of similar age (83 vs. 85 years old), but were significantly more likely to have CAD (65.6% vs. 50.1%). Antiplatelet and anticoagulant usage following TAVR was not significantly different between patients with and without PAD. At 1 year follow-up, patients with PAD had a higher incidence of death (16.9 vs. 14.5%; adjusted HR 1.13, p < 0.01) and bleeding (23.1 vs. 19.7%; HR 1.12, p < 0.01), and a trend toward higher incidence of MI (2.0 vs. 1.3%; HR 1.24, p = 0.08) (Figure).
Conclusions: PAD is common among patients undergoing commercial TAVR via TF access, and is associated with a higher risk of death and bleeding at 1-year follow-up.
Moderated Poster Contributions
Interventional Cardiology Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 10:15 a.m.-10:25 a.m.
Session Title: Peripheral Arterial Disease, Risk, and Outcomes
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1306M-07
- 2017 American College of Cardiology Foundation