Clinical research in cardiology : official journal of the German Cardiac Society · 2026
Prognostic impact of iliofemoral access-site calcification volume on outcomes after transcatheter aortic valve implantation.
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Vij Vivian, Schauwienold Katja, Shamekhi Jasmin, Muli Samuel, Basha Mustafa, Markidis Eleftherios, Zietzer Andreas, Düsing Philip, Al Zaidi Muntadher, Weber Marcel, Al-Kassou Lara, Zeus Tobias, Mauri Victor, Adam Matti, Schröder Jörg, Baldus Stephan, Kelm Malte, Marx Nikolaus, Bakhtiary Farhad, Lüsebrink Enzo, Zimmer Sebastian, Nickenig Georg, Sedaghat Alexander, Al-Kassou Baravan
Аннотация
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is increasingly performed in patients at low and intermediate risk, emphasizing the need for accurate long-term risk stratification. Although iliofemoral calcification influences procedural planning, its prognostic relevance beyond peri-procedural complications remains uncertain.
OBJECTIVES: To evaluate the prognostic value of quantitatively assessed iliofemoral access-site calcification (IASC) for outcomes after TAVI.
METHODS: The study included 1067 patients undergoing TAVI. Pre-procedural computed tomography (CT) was used to quantify IASC-volume along the transfemoral access route. Patients were stratified according to the median IASC-volume, and outcomes were compared using propensity score matching (PSM). The primary endpoint was all-cause mortality at 1, 3, and 5 years. Secondary endpoints included peri-procedural complications at 30 days.
RESULTS: The median IASC-volume was 907 (356-1839) mm3. Patients with high IASC-volume had higher prevalence of vascular comorbidities and increased risk scores. IASC-volume was not associated with vascular or bleeding complications. The overall 1-year mortality was 11.7% and did not differ between patients with low and high IASC-volume (10.5% vs. 12.8%; p = 0.20). In contrast, patients with high IASC-volume experienced significantly higher mortality at 3 years (34.3% vs. 22.3%; p < 0.01) and 5 years (42.2% vs. 28.7%; p < 0.01). These findings remained consistent after PSM. In multivariable analysis, IASC-volume was independently associated with long-term mortality (HR 1.24, 95% CI 1.11-1.38; p < 0.01).
CONCLUSION: CT-derived IASC-volume is associated with mid- and long-term mortality after TAVI, without affecting short-term or procedural outcomes. These findings suggest that IASC-volume reflects systemic disease burden and may provide incremental prognostic information beyond established risk scores.
OBJECTIVES: To evaluate the prognostic value of quantitatively assessed iliofemoral access-site calcification (IASC) for outcomes after TAVI.
METHODS: The study included 1067 patients undergoing TAVI. Pre-procedural computed tomography (CT) was used to quantify IASC-volume along the transfemoral access route. Patients were stratified according to the median IASC-volume, and outcomes were compared using propensity score matching (PSM). The primary endpoint was all-cause mortality at 1, 3, and 5 years. Secondary endpoints included peri-procedural complications at 30 days.
RESULTS: The median IASC-volume was 907 (356-1839) mm3. Patients with high IASC-volume had higher prevalence of vascular comorbidities and increased risk scores. IASC-volume was not associated with vascular or bleeding complications. The overall 1-year mortality was 11.7% and did not differ between patients with low and high IASC-volume (10.5% vs. 12.8%; p = 0.20). In contrast, patients with high IASC-volume experienced significantly higher mortality at 3 years (34.3% vs. 22.3%; p < 0.01) and 5 years (42.2% vs. 28.7%; p < 0.01). These findings remained consistent after PSM. In multivariable analysis, IASC-volume was independently associated with long-term mortality (HR 1.24, 95% CI 1.11-1.38; p < 0.01).
CONCLUSION: CT-derived IASC-volume is associated with mid- and long-term mortality after TAVI, without affecting short-term or procedural outcomes. These findings suggest that IASC-volume reflects systemic disease burden and may provide incremental prognostic information beyond established risk scores.