Association of peripheral artery disease with in-hospital outcomes after endovascular transcatheter aortic valve replacement

Divyanshu Mohananey, Pedro Villablanca, Tanush Gupta, Sagar Ranka, Nirmanmoh Bhatia, Oluwole Adegbala, Tomo Ando, Dee Dee Wang, Jose M. Wiley, Marvin Eng, Ankur Kalra, Harish Ramakrishna, Binita Shah, William O'Neill, Jorge Saucedo, Deepak L. Bhatt

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StatePublished - Jan 1 2019

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Peripheral Arterial Disease
Hospital Mortality
Acute Kidney Injury
Blood Vessels
Length of Stay
Stroke
Transcatheter Aortic Valve Replacement
Hemorrhage
Aortic Valve
Comorbidity
Inpatients
Myocardial Infarction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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Association of peripheral artery disease with in-hospital outcomes after endovascular transcatheter aortic valve replacement. / Mohananey, Divyanshu; Villablanca, Pedro; Gupta, Tanush; Ranka, Sagar; Bhatia, Nirmanmoh; Adegbala, Oluwole; Ando, Tomo; Wang, Dee Dee; Wiley, Jose M.; Eng, Marvin; Kalra, Ankur; Ramakrishna, Harish; Shah, Binita; O'Neill, William; Saucedo, Jorge; Bhatt, Deepak L.

In: Catheterization and Cardiovascular Interventions, 01.01.2019.

Research output: Contribution to journalArticle

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, DL 2019, 'Association of peripheral artery disease with in-hospital outcomes after endovascular transcatheter aortic valve replacement', Catheterization and Cardiovascular Interventions. https://doi.org/10.1002/ccd.28310
Mohananey, Divyanshu ; Villablanca, Pedro ; Gupta, Tanush ; Ranka, Sagar ; Bhatia, Nirmanmoh ; Adegbala, Oluwole ; Ando, Tomo ; Wang, Dee Dee ; Wiley, Jose M. ; Eng, Marvin ; Kalra, Ankur ; Ramakrishna, Harish ; Shah, Binita ; O'Neill, William ; Saucedo, Jorge ; Bhatt, Deepak L. / Association of peripheral artery disease with in-hospital outcomes after endovascular transcatheter aortic valve replacement. In: Catheterization and Cardiovascular Interventions. 2019.
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title = "Association of peripheral artery disease with in-hospital outcomes after endovascular transcatheter aortic valve replacement",
abstract = "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 = "Divyanshu Mohananey and Pedro Villablanca and Tanush Gupta and Sagar Ranka and Nirmanmoh Bhatia and Oluwole Adegbala and Tomo Ando and Wang, {Dee Dee} and Wiley, {Jose M.} and Marvin Eng and Ankur Kalra and Harish Ramakrishna and Binita Shah and William O'Neill and Jorge Saucedo and Bhatt, {Deepak L.}",
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T1 - Association of peripheral artery disease with in-hospital outcomes after endovascular transcatheter aortic valve replacement

AU - Mohananey, Divyanshu

AU - Villablanca, Pedro

AU - Gupta, Tanush

AU - Ranka, Sagar

AU - Bhatia, Nirmanmoh

AU - Adegbala, Oluwole

AU - Ando, Tomo

AU - Wang, Dee Dee

AU - Wiley, Jose M.

AU - Eng, Marvin

AU - Kalra, Ankur

AU - Ramakrishna, Harish

AU - Shah, Binita

AU - O'Neill, William

AU - Saucedo, Jorge

AU - Bhatt, Deepak L.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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