Impact of post-procedural hyperglycemia on acute kidney injury after transcatheter aortic valve implantation

Francesco Giannini, Azeem Latib, Richard J. Jabbour, Neil Ruparelia, Andrea Aurelio, Marco B. Ancona, Filippo Figini, Antonio Mangieri, Damiano Regazzoli, Akihito Tanaka, Claudio Montalto, Lorenzo Azzalini, Fabrizio Monaco, Eustachio Agricola, Alaide Chieffo, Matteo Montorfano, Ottavio Alfieri, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background Post-operative hyperglycemia, in individuals with and without diabetes, has been identified as a predictor of acute kidney injury (AKI) in patients following cardiac surgery. Whether or not this is also true for patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. Objectives To evaluate whether post-procedural glucose levels are associated with AKI after TAVI. Methods and results A total of 422 consecutive patients undergoing transfemoral TAVI were included in the analysis. For each patient, plasma glucose levels were assessed at hospital admission, 4 h after the procedure and daily during hospitalization. Post-procedural hyperglycemia was defined as 2 consecutive blood glucose readings ≥ 150 mg/dL in the 72-hour period following TAVI. AKI was defined according to the VARC consensus report regarding standardized endpoint definitions. Overall, 137 (32.5%) patients developed post-procedural hyperglycemia and 138 (33%) patients developed AKI. Hyperglycemia was associated with a 2-fold higher incidence of AKI than in patients without hyperglycemia (48% vs. 25%, p < 0.001). In-hospital mortality was higher in patients with hyperglycemia than in those without hyperglycemia (9.6% vs. 1.8%, p < 0.001). In-hospital mortality rate was also higher in patients who developed AKI (12.7% vs. 2.7%, p < 0.001). Patients with acute hyperglycemia that developed AKI had the highest in-hospital and long-term mortality rate (15% and 38%). Post-procedural hyperglycemia was an independent predictor of AKI. Conclusions Post-procedural hyperglycemia is associated with a higher incidence of AKI and mortality after TAVI. Randomized controlled trials are needed to determine whether meticulous post-procedural glycemic control following TAVI impacts upon clinical outcomes.

Original languageEnglish (US)
Pages (from-to)892-897
Number of pages6
JournalInternational Journal of Cardiology
Volume221
DOIs
StatePublished - Oct 15 2016
Externally publishedYes

Keywords

  • Acute kidney injury
  • Hyperglycemia
  • Post-procedural
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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