Change in estimated glomerular filtration rate within 72 hours after TAVI was a strong predictor of 1-year mortality (OR 0.97; 95% CI 0.96-0.98; P<0.0001).
Cohort (n=458)
Does acute kidney injury after TAVI predict mortality in patients undergoing routine TAVI?
Acute renal impairment within 72 hours post-TAVI is a significant risk factor for 1-year mortality and improves risk stratification beyond the EuroSCORE.
Effect estimate: OR 0.97 (95% CI 0.96-0.98)
p-value: p=<0.0001
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.
Schnabel et al. (Fri,) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=458). Transcatheter aortic valve implantation (TAVI) was evaluated on 1-year mortality (OR 0.97, 95% CI 0.96-0.98, p=<0.0001). Change in estimated glomerular filtration rate within 72 hours after TAVI was a strong predictor of 1-year mortality (OR 0.97; 95% CI 0.96-0.98; P<0.0001).