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Kidney injury and mortality after transcatheter aortic valve implantation in a routine clinical cohort
Author(s) -
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
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25588
Subject(s) - medicine , renal function , odds ratio , body mass index , acute kidney injury , confidence interval , cardiology , cohort , surgery
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. © 2014 Wiley Periodicals, Inc.