Ankle–brachial pressure index as a predictor of the 2-year outcome after transcatheter aortic valve replacement: data from the Japanese OCEAN-TAVI Registry

On behalf of OCEAN-TAVI Registry

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Abstract

Peripheral artery disease plays a pivotal role for access site selection in transcatheter aortic valve replacement (TAVR). Abnormal ankle–brachial index (ABI) is a generalized mortality marker in many cardiovascular scenarios. However, the long-term outcomes in high-risk TAVR populations remain unclear. We investigated the association between low ABI and 2-year outcome after TAVR. Of 1613 patients enrolled in the OCEAN-TAVI registry, 1458 (90.4%) who underwent ABI before TAVR were divided into groups: patients with (1) ABI ≥ 0.9 in both legs and (2) ABI < 0.9 in either leg. Primary endpoint was all-cause death within 2 years. ABI < 0.9 was noted in 304 patients (20.8%). ABI < 0.9-group had more frequent and severe comorbidities. Primary endpoint in ABI < 0.9-group was significantly higher than that in ABI ≥ 0.9-group (15.8 vs. 8.7%, p < 0.001). This trend continued in the transfemoral (TF)-approach (14.9 vs. 7.5%, p < 0.001), but not in the alternative approach (17.2 vs. 15.8%, p = 0.815). Within 30 days, ABI < 0.9-group had a higher cardiac death rate (3.1 vs. 1.0%, p = 0.033), whereas between 31 days and 2 years, non-cardiovascular death was more frequently observed (9.2 vs. 5.1%, p = 0.003). In ABI < 0.9-group, in-hospital vascular complications (11.9 vs. 4.9%, p < 0.001) and acute kidney injury (10.8 vs, 5.7%, p = 0.009) were more frequently found when using the transfemoral-approach. In multivariate analysis, ABI < 0.9 was an independent predictor of 2-year mortality (adjusted hazard ratio 1.495, 95% CI 1.007–2.220, p = 0.046). Pre-procedure ABI < 0.9 is a useful prognostic marker for all-cause mortality, even in high-risk TAVR populations.

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalHeart and Vessels
DOIs
Publication statusAccepted/In press - 2017 Dec 11

Fingerprint

Registries
Pressure
Mortality
Leg
Peripheral Arterial Disease
Acute Kidney Injury
Population
Blood Vessels
Comorbidity
Cause of Death
Multivariate Analysis
Transcatheter Aortic Valve Replacement

Keywords

  • Ankle–brachial index
  • Long-term outcome
  • Peripheral artery disease
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{424b2de94c0c44e595ff44e5a7e96113,
title = "Ankle–brachial pressure index as a predictor of the 2-year outcome after transcatheter aortic valve replacement: data from the Japanese OCEAN-TAVI Registry",
abstract = "Peripheral artery disease plays a pivotal role for access site selection in transcatheter aortic valve replacement (TAVR). Abnormal ankle–brachial index (ABI) is a generalized mortality marker in many cardiovascular scenarios. However, the long-term outcomes in high-risk TAVR populations remain unclear. We investigated the association between low ABI and 2-year outcome after TAVR. Of 1613 patients enrolled in the OCEAN-TAVI registry, 1458 (90.4{\%}) who underwent ABI before TAVR were divided into groups: patients with (1) ABI ≥ 0.9 in both legs and (2) ABI < 0.9 in either leg. Primary endpoint was all-cause death within 2 years. ABI < 0.9 was noted in 304 patients (20.8{\%}). ABI < 0.9-group had more frequent and severe comorbidities. Primary endpoint in ABI < 0.9-group was significantly higher than that in ABI ≥ 0.9-group (15.8 vs. 8.7{\%}, p < 0.001). This trend continued in the transfemoral (TF)-approach (14.9 vs. 7.5{\%}, p < 0.001), but not in the alternative approach (17.2 vs. 15.8{\%}, p = 0.815). Within 30 days, ABI < 0.9-group had a higher cardiac death rate (3.1 vs. 1.0{\%}, p = 0.033), whereas between 31 days and 2 years, non-cardiovascular death was more frequently observed (9.2 vs. 5.1{\%}, p = 0.003). In ABI < 0.9-group, in-hospital vascular complications (11.9 vs. 4.9{\%}, p < 0.001) and acute kidney injury (10.8 vs, 5.7{\%}, p = 0.009) were more frequently found when using the transfemoral-approach. In multivariate analysis, ABI < 0.9 was an independent predictor of 2-year mortality (adjusted hazard ratio 1.495, 95{\%} CI 1.007–2.220, p = 0.046). Pre-procedure ABI < 0.9 is a useful prognostic marker for all-cause mortality, even in high-risk TAVR populations.",
keywords = "Ankle–brachial index, Long-term outcome, Peripheral artery disease, Transcatheter aortic valve replacement",
author = "{On behalf of OCEAN-TAVI Registry} and Masahiro Yamawaki and Motoharu Araki and Tsutomu Ito and Yosuke Honda and Takahiro Tokuda and Yoshiaki Ito and Hiroshi Ueno and Kazuki Mizutani and Minoru Tabata and Akihiro Higashimori and Norio Tada and Kensuke Takagi and Futoshi Yamanaka and Toru Naganuma and Yusuke Watanabe and Masanori Yamamoto and Shinichi Shirai and Kentaro Hayashida",
year = "2017",
month = "12",
day = "11",
doi = "10.1007/s00380-017-1096-y",
language = "English",
pages = "1--11",
journal = "Heart and Vessels",
issn = "0910-8327",
publisher = "Springer Japan",

}

TY - JOUR

T1 - Ankle–brachial pressure index as a predictor of the 2-year outcome after transcatheter aortic valve replacement

T2 - data from the Japanese OCEAN-TAVI Registry

AU - On behalf of OCEAN-TAVI Registry

AU - Yamawaki, Masahiro

AU - Araki, Motoharu

AU - Ito, Tsutomu

AU - Honda, Yosuke

AU - Tokuda, Takahiro

AU - Ito, Yoshiaki

AU - Ueno, Hiroshi

AU - Mizutani, Kazuki

AU - Tabata, Minoru

AU - Higashimori, Akihiro

AU - Tada, Norio

AU - Takagi, Kensuke

AU - Yamanaka, Futoshi

AU - Naganuma, Toru

AU - Watanabe, Yusuke

AU - Yamamoto, Masanori

AU - Shirai, Shinichi

AU - Hayashida, Kentaro

PY - 2017/12/11

Y1 - 2017/12/11

N2 - Peripheral artery disease plays a pivotal role for access site selection in transcatheter aortic valve replacement (TAVR). Abnormal ankle–brachial index (ABI) is a generalized mortality marker in many cardiovascular scenarios. However, the long-term outcomes in high-risk TAVR populations remain unclear. We investigated the association between low ABI and 2-year outcome after TAVR. Of 1613 patients enrolled in the OCEAN-TAVI registry, 1458 (90.4%) who underwent ABI before TAVR were divided into groups: patients with (1) ABI ≥ 0.9 in both legs and (2) ABI < 0.9 in either leg. Primary endpoint was all-cause death within 2 years. ABI < 0.9 was noted in 304 patients (20.8%). ABI < 0.9-group had more frequent and severe comorbidities. Primary endpoint in ABI < 0.9-group was significantly higher than that in ABI ≥ 0.9-group (15.8 vs. 8.7%, p < 0.001). This trend continued in the transfemoral (TF)-approach (14.9 vs. 7.5%, p < 0.001), but not in the alternative approach (17.2 vs. 15.8%, p = 0.815). Within 30 days, ABI < 0.9-group had a higher cardiac death rate (3.1 vs. 1.0%, p = 0.033), whereas between 31 days and 2 years, non-cardiovascular death was more frequently observed (9.2 vs. 5.1%, p = 0.003). In ABI < 0.9-group, in-hospital vascular complications (11.9 vs. 4.9%, p < 0.001) and acute kidney injury (10.8 vs, 5.7%, p = 0.009) were more frequently found when using the transfemoral-approach. In multivariate analysis, ABI < 0.9 was an independent predictor of 2-year mortality (adjusted hazard ratio 1.495, 95% CI 1.007–2.220, p = 0.046). Pre-procedure ABI < 0.9 is a useful prognostic marker for all-cause mortality, even in high-risk TAVR populations.

AB - Peripheral artery disease plays a pivotal role for access site selection in transcatheter aortic valve replacement (TAVR). Abnormal ankle–brachial index (ABI) is a generalized mortality marker in many cardiovascular scenarios. However, the long-term outcomes in high-risk TAVR populations remain unclear. We investigated the association between low ABI and 2-year outcome after TAVR. Of 1613 patients enrolled in the OCEAN-TAVI registry, 1458 (90.4%) who underwent ABI before TAVR were divided into groups: patients with (1) ABI ≥ 0.9 in both legs and (2) ABI < 0.9 in either leg. Primary endpoint was all-cause death within 2 years. ABI < 0.9 was noted in 304 patients (20.8%). ABI < 0.9-group had more frequent and severe comorbidities. Primary endpoint in ABI < 0.9-group was significantly higher than that in ABI ≥ 0.9-group (15.8 vs. 8.7%, p < 0.001). This trend continued in the transfemoral (TF)-approach (14.9 vs. 7.5%, p < 0.001), but not in the alternative approach (17.2 vs. 15.8%, p = 0.815). Within 30 days, ABI < 0.9-group had a higher cardiac death rate (3.1 vs. 1.0%, p = 0.033), whereas between 31 days and 2 years, non-cardiovascular death was more frequently observed (9.2 vs. 5.1%, p = 0.003). In ABI < 0.9-group, in-hospital vascular complications (11.9 vs. 4.9%, p < 0.001) and acute kidney injury (10.8 vs, 5.7%, p = 0.009) were more frequently found when using the transfemoral-approach. In multivariate analysis, ABI < 0.9 was an independent predictor of 2-year mortality (adjusted hazard ratio 1.495, 95% CI 1.007–2.220, p = 0.046). Pre-procedure ABI < 0.9 is a useful prognostic marker for all-cause mortality, even in high-risk TAVR populations.

KW - Ankle–brachial index

KW - Long-term outcome

KW - Peripheral artery disease

KW - Transcatheter aortic valve replacement

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U2 - 10.1007/s00380-017-1096-y

DO - 10.1007/s00380-017-1096-y

M3 - Article

C2 - 29230568

AN - SCOPUS:85037705450

SP - 1

EP - 11

JO - Heart and Vessels

JF - Heart and Vessels

SN - 0910-8327

ER -