Incidence and impact of renal dysfunction on clinical outcomes after transcatheter aortic valve implantation.

Franzone, Anna; Stortecky, Stefan; Pilgrim, Thomas; Asami, Masahiko; Lanz, Jonas; Heg, Dik; Langhammer, Bettina; Piccolo, Raffaele; Lee, Joe K T; Praz, Fabien; Räber, Lorenz; Valgimigli, Marco; Roost, Eva; Windecker, Stephan (2018). Incidence and impact of renal dysfunction on clinical outcomes after transcatheter aortic valve implantation. International journal of cardiology, 250, pp. 73-79. Elsevier 10.1016/j.ijcard.2017.09.201

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BACKGROUND The impact of baseline renal dysfunction on early and late clinical outcomes after transcatheter aortic valve implantation (TAVI) remains to be defined. METHODS 927 patients included in the prospective Bern TAVI registry were classified on the basis of the baseline estimated glomerular filtration rate (eGFR), as having none or mild (eGFR ≥60mL/min/1.73m2, n=284, 30.6%), moderate (eGFR between 30 and 59mL/min/1.73m2, n=535, 57.7%) and severe (eGFR <30mL/min/1.73m2, n=108, 11.7%) renal dysfunction. RESULTS A graded relationship between stages of renal dysfunction and increasing risk profile was observed with higher STS score and lower left ventricular ejection fraction among patients with eGFR<30 (p<0.001 across groups). In patients with none or mild, moderate, and severe renal dysfunction the rate of all-cause mortality was 1.8%, 5.2% and 8.3% at 30-day and 11.0%, 15.0% and 19.5% at 1-year, respectively. After adjusting for relevant confounders, severe renal dysfunction was associated with an increased risk of cardiovascular death (adjusted Hazard Ratio, HRadj, 3.90, 95% Confidence Interval, CI 1.15-13.2) and stage 3 acute kidney injury (HRadj 5.15, 95% CI 1.72-15.5) at 30-day follow-up, however no significant association was found for clinical outcomes at 1-year follow-up. Moreover, moderate and severe renal dysfunction were found to be associated with bleeding at 1-year follow-up (HRadj, 1.36, 95% CI 1.04-1.78 and HRadj 1.49, 95% CI 1.00-2.21, respectively). CONCLUSIONS Pre-procedural renal dysfunction differentially affects early clinical outcomes, although the magnitude of this association is diluted over time by the overriding effect of underlying risk and comorbidities.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Franzone, Anna; Stortecky, Stefan; Pilgrim, Thomas; Asami, Masahiko; Lanz, Jonas; Heg, Dierik Hans; Piccolo, Raffaele; Praz, Fabien; Räber, Lorenz; Valgimigli, Marco; Roost, Eva and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0167-5273

Publisher:

Elsevier

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

09 Jan 2018 16:32

Last Modified:

10 Jan 2018 08:31

Publisher DOI:

10.1016/j.ijcard.2017.09.201

PubMed ID:

28993000

Additional Information:

Franzone & Stortecky contributed equally to this work.

Uncontrolled Keywords:

Clinical outcomes Renal dysfunction Transcatheter aortic valve implantation

BORIS DOI:

10.7892/boris.108822

URI:

https://boris.unibe.ch/id/eprint/108822

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