Kidney injury and mortality after transcatheter aortic valve implantation in a routine clinical cohort
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Kidney injury and mortality after transcatheter aortic valve implantation in a routine clinical cohort. / Schnabel, Renate B.; Seiffert, Moritz; Wilde, Sandra; Schirmer, Johannes; Koschyk, Dietmar H.; Conradi, Lenard; Ojeda, Francisco; Baldus, Stephan; Reichenspurner, Hermann; Blankenberg, Stefan; Treede, Hendrik; Diemert, Patrick.
in: CATHETER CARDIO INTE, Jahrgang 85, Nr. 3, 01.02.2015, S. 440-447.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Kidney injury and mortality after transcatheter aortic valve implantation in a routine clinical cohort
AU - Schnabel, Renate B.
AU - Seiffert, Moritz
AU - Wilde, Sandra
AU - Schirmer, Johannes
AU - Koschyk, Dietmar H.
AU - Conradi, Lenard
AU - Ojeda, Francisco
AU - Baldus, Stephan
AU - Reichenspurner, Hermann
AU - Blankenberg, Stefan
AU - Treede, Hendrik
AU - Diemert, Patrick
N1 - Publisher Copyright: © 2014 Wiley Periodicals, Inc.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Objectives: We aimed at identifying predictors of renal impairment and its impact on long-term outcome after transcatheter aortic valve implantation (TAVI). Background: Renal impairment is common in mostly elderly, multimorbid patients undergoing TAVI. The risk of periprocedural renal function impairment and its association with outcome is incompletely understood. Methods: In 458 consecutive patients (mean age, 80.6 ± 7.0 years, 52.2% women) who underwent routine TAVI procedures, we assessed estimated glomerular filtration rate (eGFR) at baseline, during 72-hr postprocedure and at discharge. Over a median follow-up of 0.96 years, we observed 142 deaths. Results: In multivariable-adjusted models, predictors of renal function deterioration within 72 hr were baseline eGFR (β = 0.83, 95% confidence interval [CI] = 0.76/0.91; P < 0.0001), body mass index (β = -1.20, 95% CI = 1.77/-0.62; P < 0.0001), and major access site complications (β = -14.82, 95% CI = -26.52/-3.11; P = 0.013) including bleeding (β = -11.97, 95% CI = -21.05/-2.89; P = 0.0099). Strongest renal function predictor of 1-year mortality in risk factor adjusted analyses was the change of eGFR within 72 hr (odds ratio, 0.97; 95% CI = 0.96/0.98; P < 0.0001). The addition of information on the change of eGFR increased the C-statistic of the logistic EuroSCORE (P = 0.021). Conclusions: In our routine TAVI sample, baseline eGFR, body mass index, and major access site complications mainly owing to bleeding were correlates of acute kidney injury after TAVI. Acute renal impairment was a risk factor for mortality and adverse cardiovascular events which provided risk information beyond the EuroSCORE.
AB - Objectives: We aimed at identifying predictors of renal impairment and its impact on long-term outcome after transcatheter aortic valve implantation (TAVI). Background: Renal impairment is common in mostly elderly, multimorbid patients undergoing TAVI. The risk of periprocedural renal function impairment and its association with outcome is incompletely understood. Methods: In 458 consecutive patients (mean age, 80.6 ± 7.0 years, 52.2% women) who underwent routine TAVI procedures, we assessed estimated glomerular filtration rate (eGFR) at baseline, during 72-hr postprocedure and at discharge. Over a median follow-up of 0.96 years, we observed 142 deaths. Results: In multivariable-adjusted models, predictors of renal function deterioration within 72 hr were baseline eGFR (β = 0.83, 95% confidence interval [CI] = 0.76/0.91; P < 0.0001), body mass index (β = -1.20, 95% CI = 1.77/-0.62; P < 0.0001), and major access site complications (β = -14.82, 95% CI = -26.52/-3.11; P = 0.013) including bleeding (β = -11.97, 95% CI = -21.05/-2.89; P = 0.0099). Strongest renal function predictor of 1-year mortality in risk factor adjusted analyses was the change of eGFR within 72 hr (odds ratio, 0.97; 95% CI = 0.96/0.98; P < 0.0001). The addition of information on the change of eGFR increased the C-statistic of the logistic EuroSCORE (P = 0.021). Conclusions: In our routine TAVI sample, baseline eGFR, body mass index, and major access site complications mainly owing to bleeding were correlates of acute kidney injury after TAVI. Acute renal impairment was a risk factor for mortality and adverse cardiovascular events which provided risk information beyond the EuroSCORE.
KW - CHF - Congestive heart failure
KW - CRI - chronic renal insufficiency
KW - VVLV - valvular heart disease
UR - http://www.scopus.com/inward/record.url?scp=84923102094&partnerID=8YFLogxK
U2 - 10.1002/ccd.25588
DO - 10.1002/ccd.25588
M3 - SCORING: Journal article
C2 - 24975883
AN - SCOPUS:84923102094
VL - 85
SP - 440
EP - 447
JO - CATHETER CARDIO INTE
JF - CATHETER CARDIO INTE
SN - 1522-1946
IS - 3
ER -