Open AccessCystatin C in risk prediction after transcatheter aortic valve replacement: a retrospective analysis
Author(s) -
Kuwabara Kensuke,
Zen Kan,
Yashige Masaki,
Takamatsu Kazuaki,
Ito Nobuyasu,
Kadoya Yoshito,
Yamano Michiyo,
Yamano Tetsuhiro,
Nakamura Takeshi,
Yaku Hitoshi,
Matoba Satoaki
Publication year - 2022
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.13977
Subject(s) - medicine , kidney disease , cardiology , interquartile range , renal function , cystatin c , creatinine , myocardial infarction , stroke (engine) , heart failure , retrospective cohort study , valve replacement , aortic valve stenosis , stenosis , mechanical engineering , engineering
Aims No study has evaluated the prognostic value of the chronic kidney disease (CKD) classification by cystatin C‐based estimated glomerular filtration rate (eGFR) (CKD Cys classification) in patients undergoing transcatheter aortic valve replacement (TAVR). This study aimed to compare the prognostic value of CKD Cys classification and CKD classification by creatinine‐based eGFR (CKD Cr classification) in risk prediction after TAVR. Methods and results We retrospectively analysed consecutive 219 patients with symptomatic severe aortic stenosis who underwent TAVR at our institute between December 2016 and June 2019. Pre‐operative CKD Cr and CKD Cys classifications were evaluated for their prognostic value of 2‐year major adverse cardiovascular and cerebrovascular events (MACCE) after TAVR. MACCE was defined as the composite of all‐cause mortality, non‐fatal myocardial infarction, stroke, and rehospitalization for worsening congestive heart failure. Participants had a median age of 86.0 years and were predominantly female (76.9%). In 96.6% of the cases, TAVR was performed using transfemoral access. The median creatinine‐based eGFR (52.85 mL/min/1.73 m 2 ) was higher than the cystatin C‐based eGFR (41.50 mL/min/1.73 m 2 ). Downward reclassification in CKD stages based on eGFR Cys was observed in 49.0% of patients. During a median follow‐up period of 575.5 (interquartile range: 367.0–730.0) days, 58 patients presented with MACCE. CKD Cys classification, but not CKD Cr classification, significantly stratified the risk of 2‐year MACCE in patients after TAVR by log‐rank test ( P = 0.003). In multivariate Cox regression analysis, only CKD Cys stage 3b [hazard ratio (HR) = 4.37; 95% confidence interval (CI): 1.28–14.91; P = 0.019] and CKD Cys stage 4 + 5 (HR = 3.72; 95% CI: 1.06–12.99; P = 0.040) were significant predictors of MACCE after adjustment for potential confounders. Conclusions The CKD Cys classification could better assess the risk than the CKD Cr classification in patients undergoing TAVR. CKD Cys stage 3b and stage 4 + 5 correlated with adverse outcomes.