Kidney injury and mortality after transcatheter aortic valve implantation in a routine clinical cohort

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 -