TY - JOUR
T1 - Acute kidney injury after transcatheter aortic valve implantation with self-expanding CoreValve prosthesis
T2 - Results from a large multicentre Italian research project
AU - Barbanti, Marco
AU - Latib, Azeem
AU - Sgroi, Carmelo
AU - Fiorina, Claudia
AU - De Carlo, Marco
AU - Bedogni, Francesco
AU - De Marco, Federico
AU - Ettori, Federica
AU - Petronio, Anna Sonia
AU - Colombo, Antonio
AU - Testa, Luca
AU - Klugmann, Silvio
AU - Poli, Arnaldo
AU - Maffeo, Diego
AU - Maisano, Francesco
AU - Aruta, Patrizia
AU - Gulino, Simona
AU - Giarratana, Alessandra
AU - Patané, Martina
AU - Cannata, Stefano
AU - Immé, Sebastiano
AU - Mangoni, Lorenza
AU - Rossi, Agnese
AU - Tamburino, Corrado
PY - 2014/5
Y1 - 2014/5
N2 - Aims: Transcatheter aortic valve implantation (TAVI) can be associated with varying degrees of new renal impairment. The aim of this multicentre analysis was to determine the impact and predictors of periprocedural acute kidney injury (AKI) on prognosis after TAVI. Methods and results: From the ClinicalService® (a nation-based data repository and medical care project) dataset, 1,157 patients with severe aortic stenosis treated with the third-generation CoreValve prosthesis in seven Italian sites, and with creatinine data available at baseline and during the post-TAVI in-hospital course, were included in this analysis. All outcomes were defined according to the VARC criteria. Overall, AKI occurred in 231 (20.0%): 15.4% stage 1, 2.7% stage 2, and 1.9% stage 3. Compared to patients without AKI, patients who suffered post-procedural AKI had significantly higher three-year all-cause mortality (31% vs. 12%; adjusted HR: 2.09; 95% CI: 1.52-2.87, p>0.001) and cardiovascular mortality (14% vs. 6%; adjusted HR: 2.28; 95% CI: 1.41-3.71, p=0.001). No significant differences in terms of stroke, spontaneous MI, and bleeding were reported. Female gender (adjusted OR: 1.37, 95% CI: 1.01-1.87; p=0.045), baseline renal insufficiency (adjusted OR: 11.02, 95% CI: 5.12-23.73; p>0.001), general anaesthesia (adjusted OR: 1.37, 95% CI: 1.00-1.87; p=0.050), and transfusion =3 red blood cell (RBC) units within 72 hrs from TAVI (adjusted OR: 1.65, 95% CI: 1.02-2.68; p=0.041) were found to be independent predictors of AKI. Conclusions: Acute kidney injury is a frequent complication and significantly impacts on both early and long-term TAVI survival. Females, subjects with impaired renal function at baseline, patients undergoing TAVI under general anaesthesia, and patients receiving ≤3 RBC units after the procedure should be considered populations at high risk for the development of AKI after TAVI.
AB - Aims: Transcatheter aortic valve implantation (TAVI) can be associated with varying degrees of new renal impairment. The aim of this multicentre analysis was to determine the impact and predictors of periprocedural acute kidney injury (AKI) on prognosis after TAVI. Methods and results: From the ClinicalService® (a nation-based data repository and medical care project) dataset, 1,157 patients with severe aortic stenosis treated with the third-generation CoreValve prosthesis in seven Italian sites, and with creatinine data available at baseline and during the post-TAVI in-hospital course, were included in this analysis. All outcomes were defined according to the VARC criteria. Overall, AKI occurred in 231 (20.0%): 15.4% stage 1, 2.7% stage 2, and 1.9% stage 3. Compared to patients without AKI, patients who suffered post-procedural AKI had significantly higher three-year all-cause mortality (31% vs. 12%; adjusted HR: 2.09; 95% CI: 1.52-2.87, p>0.001) and cardiovascular mortality (14% vs. 6%; adjusted HR: 2.28; 95% CI: 1.41-3.71, p=0.001). No significant differences in terms of stroke, spontaneous MI, and bleeding were reported. Female gender (adjusted OR: 1.37, 95% CI: 1.01-1.87; p=0.045), baseline renal insufficiency (adjusted OR: 11.02, 95% CI: 5.12-23.73; p>0.001), general anaesthesia (adjusted OR: 1.37, 95% CI: 1.00-1.87; p=0.050), and transfusion =3 red blood cell (RBC) units within 72 hrs from TAVI (adjusted OR: 1.65, 95% CI: 1.02-2.68; p=0.041) were found to be independent predictors of AKI. Conclusions: Acute kidney injury is a frequent complication and significantly impacts on both early and long-term TAVI survival. Females, subjects with impaired renal function at baseline, patients undergoing TAVI under general anaesthesia, and patients receiving ≤3 RBC units after the procedure should be considered populations at high risk for the development of AKI after TAVI.
KW - Aortostenosis
KW - TAVI
KW - Valvular heart disease
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U2 - 10.4244/EIJV10I1A20
DO - 10.4244/EIJV10I1A20
M3 - Article
C2 - 24213329
AN - SCOPUS:84902319114
SN - 1774-024X
VL - 10
SP - 133
EP - 140
JO - EuroIntervention
JF - EuroIntervention
IS - 1
ER -