The impact of peripheral arterial disease on left ventricular assist device implantation - A Propensity Matched Analysis of the Nationwide Inpatient Sample Database.

BACKGROUND: Left ventricular assist device (LVAD) candidacy screening includes evaluation for peripheral arterial disease (PVD). However, given current evidence, the impact of PAD on post-LVAD complications remains unknown.

METHODS: The National Inpatient Sample (NIS) database (2002-2017) was utilized to identify all LVAD cases. The in-hospital safety endpoints included major cardiovascular adverse events and its components. A propensity-matched analysis was used to obtain adjusted odds ratios (aOR). A subgroup analysis of patients with diabetes mellitus (DM) with PAD was also performed.

RESULTS: A total of 27424 patients with LVAD implantation [PAD: 516 (1.8%) and no-PAD 26908 (98.2%)] were included. There were significant intergroup differences in the demographics and baseline comorbidities. A weighted sample of 1053 (no-PAD 537, PAD 516) propensity-matched population was selected. The adjusted odds for in-hospital mortality (aOR 1.7; 95% CI, 1.2-2.44, P=0.004) were found to be significantly higher for LVAD-patients with PAD. There was no significant difference in the adjusted odds of MACE (aOR 1.16, 95% CI 0.87-1.5), post-procedure bleeding (aOR 0.88, 95% CI 0.62-1.26, P=0.54) and risk of pneumonia (aOR 0.67, 95% CI 0.44-1.15, P=0.63) between the two groups. A selected cohort of DM-only population (7339) consistently showed a higher adjusted mortality rate in PAD patients with LVAD implantation (aOR 2.3, 95% CI 1.2-4.47, p=0.01). The rate of MACE (p=0.17), myocardial infarction (p=0.12), stroke (p=0.60), post-procedural (0.10) and major bleeding (p=0.51) remained identical between patients with PAD and those with no-PAD.

CONCLUSION: PAD confers an increased risk of in-hospital all-cause mortality in patients undergoing LVAD implantation. This risk increases further in patients with a concomitant diagnosis of DM.