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The impact of chronic kidney disease in women undergoing transcatheter aortic valve replacement: Analysis from the Women's INternational Transcatheter Aortic Valve Implantation (WIN‐TAVI) registry
Author(s) -
Bandyopadhyay Dhrubajyoti,
Sartori Samantha,
Baber Usman,
Cao Davide,
Chandiramani Rishi,
Tchétché Didier,
Petronio Anna Sonia,
Mehilli Julinda,
Lefèvre Thierry,
Presbitero Patrizia,
Capranzaro Piera,
Sardella Gennaro,
Van Mieghem Nicolas M.,
Chandrasekhar Jaya,
Dumonteil Nicholas,
Fraccaro Chiara,
Trabattoni Daniela,
Mikhail Ghada W.,
Naber Christoph,
Kini Annapoorna,
Morice MarieClaude,
Claessen Bimmer E.,
Chieffo Alaide,
Mehran Roxana
Publication year - 2020
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.28752
Subject(s) - medicine , kidney disease , hazard ratio , cardiology , renal function , valve replacement , aortic valve stenosis , stenosis , percutaneous coronary intervention , confidence interval , surgery , myocardial infarction
Background The prevalence of both chronic kidney disease (CKD) and aortic stenosis (AS) increase with age. Although baseline CKD is frequent in patients undergoing transcatheter aortic valve replacement (TAVR), its significance among women is largely unknown. Methods Women's INternational Transcatheter Aortic Valve Implantation (WIN‐TAVI) is a multinational, prospective registry of women undergoing TAVR for severe AS. We included patients with available baseline estimated glomerular filtration rate (eGFR) and completed 1‐year follow‐up. Patients were categorized into three groups based on their eGFR: No CKD (normal kidney function to stage 2 CKD: eGFR ≥60 ml/min/1.73 m 2 ); (b) mild CKD (stage 3a CKD: eGFR = 45–59 ml/min/1.73 m 2 ); and (c) moderate/severe CKD (stage ≥3b CKD: eGFR <45 ml/min/1.73 m 2 ). All events were adjudicated according to the Valve Academic Research Consortium (VARC)‐2 criteria. Result Out of 852 women undergoing TAVR, 326 (38.3%) had no CKD, 225 (26.4%) had mild CKD, and 301 (35.3%) had moderate/severe CKD. Women with higher stage of CKD at baseline were more likely to have a history of hypertension, diabetes, atrial fibrillation, anemia, chronic lung disease, hemodialysis, prior percutaneous coronary intervention, and pacemaker implantation. After multivariate adjustment, moderate/severe CKD was associated with a greater risk of 1‐year VARC‐2 safety endpoints [hazard ratio (HR) 1.68, 95% confidence interval (CI): 1.10–2.60], all‐cause death (HR 2.00, 95% CI: 1.03–3.90), and composite of death, myocardial infarction, stroke or life‐threatening bleeding (HR 1.70, 95% CI: 1.04–2.76). There were no differences in 30‐day and 1‐year VARC‐2 efficacy and 30‐day VARC‐2 safety outcomes. Conclusion CKD is associated with substantial and independent risk for mortality and morbidity at 1‐year follow‐up in women undergoing TAVR.