Association and Prognostic Implications of Peripheral Arterial Disease and Calcific Aortic Stenosis

Background Calcific aortic stenosis (AS) and peripheral artery disease (PAD) share common pathophysiological mechanisms and risk factors related to atherosclerosis. However, the prevalence of PAD and its association with mortality in patients with AS remains heterogeneous and require further investigations. Objectives The aims of this study were (a) to determine the prevalence of PAD in patients with severe AS and (b) to assess the impact of PAD on mortality in these patients. Methods From June 2000 to December 2019, patients who underwent surgical aortic valve replacement (SAVR) at the Limoges University Hospital were enrolled. Over a median observational period of 7.6 years [4.9–11.4], 1462 patients were studied. PAD was defined by mention of clinical diagnosis, significant stenosis on ultrasound, or history of lower-limb revascularization. Results Patients with PAD accounted for 8.9% ( n = 130). Long-term survival of patients with PAD was significantly worse than for patients without PAD (HRa = 1.62, 1.28-2.04, P < .0001). This association was even more marked among patients with concomitant coronary artery disease (CAD) (HRa = 1.92, 1.46-2.51, P < .0001). Of note, long-term survival was similar in patients with PAD with or without CAD, and patients with PAD alone (ie, without CAD) have similar survival than those with CAD alone (ie, without PAD). Conclusions Almost one out of 10 patients with severe AS presents PAD. This comorbidity was independently associated with traditional risk factors and markedly reduced survival, increased mortality. Similarly to patients with CAD, patients with AS and concomitant PAD should be considered at high risk of poor outcome.