Aortic stenosis and peripheral artery disease: Impact on mortality following transcatheter aortic valve replacement

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.

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).

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.

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.

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.