TY - JOUR
T1 - Advanced chronic kidney disease in patients undergoing transcatheter aortic valve implantation
T2 - Insights on clinical outcomes and prognostic markers froma large cohort of patients
AU - Allende, Ricardo
AU - Webb, John G.
AU - Munoz-Garcia, Antonio J.
AU - De Jaegere, Peter
AU - Tamburino, Corrado
AU - Dager, Antonio E.
AU - Cheema, Asim
AU - Serra, Vicenç
AU - Amat-Santos, Ignacio
AU - Velianou, James L.
AU - Barbanti, Marco
AU - Dvir, Danny
AU - Alonso-Briales, Juan H.
AU - Nuis, Rutger Jan
AU - Faqiri, Elhamula
AU - Imme, Sebastiano
AU - Benitez, Luis Miguel
AU - Cucalon, Angela Maria
AU - Al Lawati, Hatim
AU - Del Blanco, Bruno Garcia
AU - Lopez, Javier
AU - Natarajan, Madhu K.
AU - DeLarochellière, Robert
AU - Urena, Marina
AU - Ribeiro, Henrique B.
AU - Dumont, Eric
AU - Nombela-Franco, Luis
AU - Rodés-Cabau, Josep
N1 - Publisher Copyright:
© The Author 2014.
PY - 2014/10/7
Y1 - 2014/10/7
N2 - Aim Theaimof this studywastodeterminetheeffects ofadvancedchronic kidneydisease(CKD)onearlyandlateoutcomes after transcatheter aortic valve implantation (TAVI), and to evaluate the predictive factors of poorer outcomes in such patients. Methods and results This was a multicentre study including a total of 2075 consecutive patients who had undergone TAVI. Patients were grouped according the estimated glomerular filtration rate as follows: CKD stage 1-2 (≥60 mL/min/1.73 m2; n = 950), stage 3 (30-59 mL/min/1.73 m2; n= 924), stage 4 (15.29 mL/min/1.73 m2; n= 134) and stage 5 (,15 mL/ min/1.73 m2 or dialysis; n= 67). Clinical outcomes were evaluated at 30-days and at follow-up (median of 15 [6.29] months) and defined according to the VARC criteria. Advanced CKD (stage 4.5) was an independent predictor of 30-day major/life-threatening bleeding (P= 0.001) and mortality (P= 0.027), and late overall, cardiovascular and noncardiovascular mortality (P < 0.01 for all). Pre-existing atrial fibrillation (HR: 2.29, 95% CI: 1.47.3.58, P= 0.001) and dialysis therapy (HR: 1.86, 95% CI: 1.17.2.97, P= 0.009)were the predictors of mortality in advanced CKDpatients, with a mortality rate as high as 71% at 1-year follow-up in those patients with these 2 factors. Advanced CKD patients who had survived at 1-year follow-up exhibited both a significant improvement inNYHAclass (P < 0.001) and no deterioration in valve hemodynamics (P= NS for changes in mean gradient and valve area over time). Conclusions AdvancedCKDwas associatedwith a higher rate of early and latemortality and bleeding events followingTAVI,with AFand dialysis therapy determining a higher risk in these patients. Themortality rate of patientswith both factorswas unacceptably high and this should be taken into account in the clinical decision-making process in this challenging group of patients.
AB - Aim Theaimof this studywastodeterminetheeffects ofadvancedchronic kidneydisease(CKD)onearlyandlateoutcomes after transcatheter aortic valve implantation (TAVI), and to evaluate the predictive factors of poorer outcomes in such patients. Methods and results This was a multicentre study including a total of 2075 consecutive patients who had undergone TAVI. Patients were grouped according the estimated glomerular filtration rate as follows: CKD stage 1-2 (≥60 mL/min/1.73 m2; n = 950), stage 3 (30-59 mL/min/1.73 m2; n= 924), stage 4 (15.29 mL/min/1.73 m2; n= 134) and stage 5 (,15 mL/ min/1.73 m2 or dialysis; n= 67). Clinical outcomes were evaluated at 30-days and at follow-up (median of 15 [6.29] months) and defined according to the VARC criteria. Advanced CKD (stage 4.5) was an independent predictor of 30-day major/life-threatening bleeding (P= 0.001) and mortality (P= 0.027), and late overall, cardiovascular and noncardiovascular mortality (P < 0.01 for all). Pre-existing atrial fibrillation (HR: 2.29, 95% CI: 1.47.3.58, P= 0.001) and dialysis therapy (HR: 1.86, 95% CI: 1.17.2.97, P= 0.009)were the predictors of mortality in advanced CKDpatients, with a mortality rate as high as 71% at 1-year follow-up in those patients with these 2 factors. Advanced CKD patients who had survived at 1-year follow-up exhibited both a significant improvement inNYHAclass (P < 0.001) and no deterioration in valve hemodynamics (P= NS for changes in mean gradient and valve area over time). Conclusions AdvancedCKDwas associatedwith a higher rate of early and latemortality and bleeding events followingTAVI,with AFand dialysis therapy determining a higher risk in these patients. Themortality rate of patientswith both factorswas unacceptably high and this should be taken into account in the clinical decision-making process in this challenging group of patients.
KW - Atrial fibrillation
KW - Chronic kidney disease
KW - Dialysis
KW - Transcatheter aortic valve implantation
UR - http://www.scopus.com/inward/record.url?scp=84917688797&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84917688797&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehu175
DO - 10.1093/eurheartj/ehu175
M3 - Article
C2 - 24796337
AN - SCOPUS:84917688797
SN - 0195-668X
VL - 35
SP - 2685
EP - 2696
JO - European Heart Journal
JF - European Heart Journal
IS - 38
ER -