Martin Faure, Louis Le Bivic, Marouane Boukhris, Andrea Cianci, Jean-David Blossier, Dounia Meddad, Lucie Chastaingt, Philippe Lacroix, Jérôme Jouan, Pierre-Marie Preux, Nicole Darodes, Victor Aboyans, Julien Magne
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However, the prevalence of PAD in calcific AS and its prognostic impact require further investigation.</p><p><strong>Aims: </strong>To describe the prevalence of PAD in patients with advanced AS requiring intervention and assess the impact of PAD on overall long-term mortality among patients undergoing transcatheter aortic valve replacement (TAVR).</p><p><strong>Methods: </strong>All patients who underwent TAVR between 2014 and 2023 in our tertiary care centre were enrolled in a retrospective cohort. PAD was defined by the mention of a clinical diagnosis in medical records, significant arterial stenosis observed on the pre-procedural angio-computed tomography scan or a history of lower-limb revascularization.</p><p><strong>Results: </strong>Among the 904 included patients (median [interquartile range] age 84.2 (79.9-87.4) years, 54.4% male), 212 (23.5%) had PAD. Patients with PAD had a significantly higher risk of mortality compared to patients without PAD (mean 5-year survival 40.0%, 95% confidence interval [CI] 32.2-49.6 vs. 52.7%, 95% CI 47.8-58.1; P=0.008; adjusted hazard ratio [aHR] 1.31, 95% confidence interval [CI] 1.03-1.66; P=0.029). Among patients without coronary artery disease (CAD), those with PAD alone had an increased risk of mortality (aHR 1.50, 95% CI 1.03-2.21; P=0.037). Importantly, patients with PAD alone had significantly reduced survival compared to those with CAD alone (i.e. without PAD) (aHR 1.49, 95% CI 1.02-2.19; P=0.040). However, the survival of patients with both PAD and CAD did not significantly differ from those with CAD without PAD.</p><p><strong>Conclusion: </strong>PAD was independently associated with increased mortality in severe calcific AS. Importantly, this excess mortality among patients with PAD was not affected by the simultaneous presence of CAD. 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However, the prevalence of PAD in calcific AS and its prognostic impact require further investigation.</p><p><strong>Aims: </strong>To describe the prevalence of PAD in patients with advanced AS requiring intervention and assess the impact of PAD on overall long-term mortality among patients undergoing transcatheter aortic valve replacement (TAVR).</p><p><strong>Methods: </strong>All patients who underwent TAVR between 2014 and 2023 in our tertiary care centre were enrolled in a retrospective cohort. PAD was defined by the mention of a clinical diagnosis in medical records, significant arterial stenosis observed on the pre-procedural angio-computed tomography scan or a history of lower-limb revascularization.</p><p><strong>Results: </strong>Among the 904 included patients (median [interquartile range] age 84.2 (79.9-87.4) years, 54.4% male), 212 (23.5%) had PAD. Patients with PAD had a significantly higher risk of mortality compared to patients without PAD (mean 5-year survival 40.0%, 95% confidence interval [CI] 32.2-49.6 vs. 52.7%, 95% CI 47.8-58.1; P=0.008; adjusted hazard ratio [aHR] 1.31, 95% confidence interval [CI] 1.03-1.66; P=0.029). Among patients without coronary artery disease (CAD), those with PAD alone had an increased risk of mortality (aHR 1.50, 95% CI 1.03-2.21; P=0.037). Importantly, patients with PAD alone had significantly reduced survival compared to those with CAD alone (i.e. without PAD) (aHR 1.49, 95% CI 1.02-2.19; P=0.040). However, the survival of patients with both PAD and CAD did not significantly differ from those with CAD without PAD.</p><p><strong>Conclusion: </strong>PAD was independently associated with increased mortality in severe calcific AS. Importantly, this excess mortality among patients with PAD was not affected by the simultaneous presence of CAD. 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引用次数: 0
摘要
背景：由于共同的病理生理和共同的危险因素，外周动脉疾病（PAD）经常出现在钙化性主动脉狭窄（AS）患者中。然而，PAD在钙化AS中的患病率及其对预后的影响需要进一步研究。目的：描述需要干预的晚期AS患者中PAD的患病率，并评估PAD对经导管主动脉瓣置换术（TAVR）患者总体长期死亡率的影响。方法：2014年至2023年在我们三级保健中心接受TAVR的所有患者纳入回顾性队列。通过在医疗记录中提及临床诊断，在手术前血管计算机断层扫描中观察到明显的动脉狭窄或下肢血运重建史来定义PAD。结果：904例纳入的患者（中位年龄84.2（79.9-87.4）岁，男性54.4%），212例（23.5%）患有PAD。PAD患者的死亡风险明显高于无PAD患者（平均5年生存率40.0%，95%可信区间[CI] 32.2-49.6比52.7%，95%可信区间[CI] 47.8-58.1； P=0.008；校正风险比[aHR] 1.31, 95%可信区间[CI] 1.03-1.66； P=0.029）。在没有冠状动脉疾病（CAD）的患者中，单独患有PAD的患者死亡风险增加（aHR 1.50, 95% CI 1.03-2.21； P=0.037）。重要的是，单独患有PAD的患者与单独患有CAD的患者（即没有PAD）相比，生存率显著降低（aHR 1.49, 95% CI 1.02-2.19； P=0.040）。然而，同时患有PAD和CAD的患者的生存率与没有PAD的CAD患者的生存率没有显著差异。结论：PAD与严重钙化AS的死亡率增加独立相关。重要的是，PAD患者的额外死亡率不受同时存在CAD的影响。与CAD患者相似，AS合并PAD患者应被认为具有高死亡率。
Aortic stenosis and peripheral artery disease: Impact on mortality following transcatheter aortic valve replacement.
Background: Due to common pathophysiology and shared risk factors, peripheral artery disease (PAD) is frequently present in patients with calcific aortic stenosis (AS). However, the prevalence of PAD in calcific AS and its prognostic impact require further investigation.
Aims: To describe the prevalence of PAD in patients with advanced AS requiring intervention and assess the impact of PAD on overall long-term mortality among patients undergoing transcatheter aortic valve replacement (TAVR).
Methods: All patients who underwent TAVR between 2014 and 2023 in our tertiary care centre were enrolled in a retrospective cohort. PAD was defined by the mention of a clinical diagnosis in medical records, significant arterial stenosis observed on the pre-procedural angio-computed tomography scan or a history of lower-limb revascularization.
Results: Among the 904 included patients (median [interquartile range] age 84.2 (79.9-87.4) years, 54.4% male), 212 (23.5%) had PAD. Patients with PAD had a significantly higher risk of mortality compared to patients without PAD (mean 5-year survival 40.0%, 95% confidence interval [CI] 32.2-49.6 vs. 52.7%, 95% CI 47.8-58.1; P=0.008; adjusted hazard ratio [aHR] 1.31, 95% confidence interval [CI] 1.03-1.66; P=0.029). Among patients without coronary artery disease (CAD), those with PAD alone had an increased risk of mortality (aHR 1.50, 95% CI 1.03-2.21; P=0.037). Importantly, patients with PAD alone had significantly reduced survival compared to those with CAD alone (i.e. without PAD) (aHR 1.49, 95% CI 1.02-2.19; P=0.040). However, the survival of patients with both PAD and CAD did not significantly differ from those with CAD without PAD.
Conclusion: PAD was independently associated with increased mortality in severe calcific AS. Importantly, this excess mortality among patients with PAD was not affected by the simultaneous presence of CAD. Similarly to patients with CAD, patients with AS and concomitant PAD should be considered at high risk of mortality.
期刊介绍：
The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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