Meta-analysis of prognostic impact of peripheral arterial disease on mortality after transcatheter aortic valve implantation

INTRODUCTION: The aim of this study was to determine whether peripheral arterial disease (PAD) is an independent predictor of mortality in patients who undergo transcatheter aortic valve implantation (TAVI) and we performed meta-analysis of currently available studies. EVIDENCE ACQUISITION: MEDLINE and EMBASE were searched through June 2018 using Web-based search engines (PubMed and OVID). We included comparative studies of patients with PAD versus those without PAD and cohort studies which investigated PAD as one of prognostic factors of mortality, which used the multivariable analysis and reported an adjusted odds and hazard ratio (OR/HR) for early (30-day or in-hospital) and late (including early) mortality after TAVI. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model. EVIDENCE SYNTHESIS: The primary meta-analysis which pooled all the ORs/HRs demonstrated that PAD was associated with a statistically significant increase in both early (OR, 1.21; P=0.02) and midterm (1-year to 7-year) mortality (HR, 1.31; P<0.00001). The secondary meta-analysis which exclusively pooled approach-adjusted/stratified ORs/HRs demonstrated that PAD was associated with a strong trend toward (though statistically non-significant) an increase in early mortality (OR, 1.18; P=0.07) and a still statistically significant increase in midterm mortality (OR, 1.24; P=0.0001). Meta-regression coefficients for the proportion of patients who underwent transfemoral TAVI were not statistically significant (P for early/midterm mortality =0.24/0.52). CONCLUSIONS: The present meta-analysis clearly highlighted that PAD was an independent predictor of both early and midterm mortality in patients who underwent TAVI.