Key result
Preexisting renal dysfunction was associated with a significantly higher risk of mid-term mortality after transcatheter aortic valve implantation compared to normal renal function (multivariate HR 1.47).
Why the study?
Does preexisting renal dysfunction increase mid-term mortality in patients with symptomatic aortic stenosis undergoing transcatheter aortic valve implantation?
Meta-Analysis (n=32,131)
Yes
Does preexisting renal dysfunction increase mid-term mortality in patients with symptomatic aortic stenosis undergoing transcatheter aortic valve implantation?
Hazard Ratio: 1.47 (95% CI 1.17–1.84)
Preexisting renal dysfunction, particularly advanced chronic kidney disease, is associated with significantly increased mid-term mortality and peri-procedural complications after TAVI.
May guide pre-TAVI risk stratification in renal impairment; leaves open whether optimization alters mid-term survival.
BACKGROUND: There is conflicting evidence regarding the impact of preexisting renal dysfunction (RD) on mid-term outcomes after transcatheter aortic valve implantation (TAVI) in patients with symptomatic aortic stenosis (AS). METHODS AND RESULTS: Forty-seven articles representing 32,131 patients with AS undergoing a TAVI procedure were included in this systematic review and meta-analysis. Pooled analyses were performed with both univariate and multivariate models, using a fixed or random effects method when appropriate. Compared with patients with normal renal function, mid-term mortality was significantly higher in patients with preexisting RD, as defined by the author (univariate hazard ratio [HR]: 1.69; 95% confidence interval [CI]: 1.50-1.90; multivariate HR: 1.47; 95% CI: 1.17-1.84), baseline estimated glomerular filtration rate (eGFR) (univariate HR: 1.65; 95% CI: 1.47-1.86; multivariate HR: 1.46; 95% CI: 1.24-1.71), and serum creatinine (univariate HR: 1.69; 95% CI: 1.48-1.92; multivariate HR: 1.65; 95% CI: 1.36-1.99). Advanced stage of chronic kidney disease (CKD stage 3-5) was strongly related to bleeding (univariate HR in CKD stage 3: 1.30, 95% CI: 1.13-1.49; in CKD stage 4: 1.30, 95% CI: 1.04-1.62), acute kidney injure (AKI) (univariate HR in CKD stage 3: 1.28, 95% CI: 1.03-1.59; in CKD stage 4: 2.27, 95% CI: 1.74-2.96), stroke (univariate HR in CKD stage 4: 3.37, 95% CI: 1.52-7.46), and mid-term mortality (univariate HR in CKD stage 3: 1.57, 95% CI: 1.26-1.95; in CKD stage 4: 2.77, 95% CI: 2.06-3.72; in CKD stage 5: 2.64, 95% CI: 1.91-3.65) compared with CKD stage 1+2. Patients with CKD stage 4 had a higher incidence of AKI (univariate HR: 1.70, 95% CI: 1.34-2.16) and all-cause death (univariate HR: 1.60, 95% CI: 1.28-1.99) compared with those with CKD stage 3. A per unit decrease in serum creatinine was also associated with a higher mortality at mid-term follow-up (univariate HR: 1.24, 95% CI: 1.18-1.30; multivariate HR: 1.19, 95% CI: 1.08-1.30). CONCLUSIONS: Preexisting RD was associated with increased mid-term mortality after TAVI. Patients with CKD stage 4 had significantly higher incidences of peri-procedural complications and a poorer prognosis, a finding that should be factored into the clinical decision-making process regarding these patients.
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Chen et al. (2015) conducted a meta-analysis in Symptomatic aortic stenosis (n=32,131). Preexisting renal dysfunction vs. Normal renal function was evaluated on Mid-term all-cause mortality (HR 1.47, 95% CI 1.17-1.84). Preexisting renal dysfunction was associated with a significantly higher risk of mid-term mortality after transcatheter aortic valve implantation compared to normal renal function (multivariate HR 1.47).
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