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.

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