Advanced chronic kidney disease in patients undergoing transcatheter aortic valve implantation: Insights on clinical outcomes and prognostic markers froma large cohort of patients

Ricardo Allende, John G. Webb, Antonio J. Munoz-Garcia, Peter De Jaegere, Corrado Tamburino, Antonio E. Dager, Asim Cheema, Vicenç Serra, Ignacio Amat-Santos, James L. Velianou, Marco Barbanti, Danny Dvir, Juan H. Alonso-Briales, Rutger Jan Nuis, Elhamula Faqiri, Sebastiano Imme, Luis Miguel Benitez, Angela Maria Cucalon, Hatim Al Lawati, Bruno Garcia Del BlancoJavier Lopez, Madhu K. Natarajan, Robert DeLarochellière, Marina Urena, Henrique B. Ribeiro, Eric Dumont, Luis Nombela-Franco, Josep Rodés-Cabau

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2685-2696
Number of pages12
JournalEuropean Heart Journal
Volume35
Issue number38
DOIs
Publication statusPublished - Oct 7 2014

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Chronic Renal Insufficiency
Dialysis
Mortality
Hemorrhage
Transcatheter Aortic Valve Replacement
Glomerular Filtration Rate
Atrial Fibrillation
Multicenter Studies
Hemodynamics
Therapeutics

Keywords

  • Atrial fibrillation
  • Chronic kidney disease
  • Dialysis
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Advanced chronic kidney disease in patients undergoing transcatheter aortic valve implantation : Insights on clinical outcomes and prognostic markers froma large cohort of patients. / Allende, Ricardo; Webb, John G.; Munoz-Garcia, Antonio J.; De Jaegere, Peter; Tamburino, Corrado; Dager, Antonio E.; Cheema, Asim; Serra, Vicenç; Amat-Santos, Ignacio; Velianou, James L.; Barbanti, Marco; Dvir, Danny; Alonso-Briales, Juan H.; Nuis, Rutger Jan; Faqiri, Elhamula; Imme, Sebastiano; Benitez, Luis Miguel; Cucalon, Angela Maria; Al Lawati, Hatim; Del Blanco, Bruno Garcia; Lopez, Javier; Natarajan, Madhu K.; DeLarochellière, Robert; Urena, Marina; Ribeiro, Henrique B.; Dumont, Eric; Nombela-Franco, Luis; Rodés-Cabau, Josep.

In: European Heart Journal, Vol. 35, No. 38, 07.10.2014, p. 2685-2696.

Research output: Contribution to journalArticle

Allende, R, Webb, JG, Munoz-Garcia, AJ, De Jaegere, P, Tamburino, C, Dager, AE, Cheema, A, Serra, V, Amat-Santos, I, Velianou, JL, Barbanti, M, Dvir, D, Alonso-Briales, JH, Nuis, RJ, Faqiri, E, Imme, S, Benitez, LM, Cucalon, AM, Al Lawati, H, Del Blanco, BG, Lopez, J, Natarajan, MK, DeLarochellière, R, Urena, M, Ribeiro, HB, Dumont, E, Nombela-Franco, L & Rodés-Cabau, J 2014, 'Advanced chronic kidney disease in patients undergoing transcatheter aortic valve implantation: Insights on clinical outcomes and prognostic markers froma large cohort of patients', European Heart Journal, vol. 35, no. 38, pp. 2685-2696. https://doi.org/10.1093/eurheartj/ehu175
Allende, Ricardo ; Webb, John G. ; Munoz-Garcia, Antonio J. ; De Jaegere, Peter ; Tamburino, Corrado ; Dager, Antonio E. ; Cheema, Asim ; Serra, Vicenç ; Amat-Santos, Ignacio ; Velianou, James L. ; Barbanti, Marco ; Dvir, Danny ; Alonso-Briales, Juan H. ; Nuis, Rutger Jan ; Faqiri, Elhamula ; Imme, Sebastiano ; Benitez, Luis Miguel ; Cucalon, Angela Maria ; Al Lawati, Hatim ; Del Blanco, Bruno Garcia ; Lopez, Javier ; Natarajan, Madhu K. ; DeLarochellière, Robert ; Urena, Marina ; Ribeiro, Henrique B. ; Dumont, Eric ; Nombela-Franco, Luis ; Rodés-Cabau, Josep. / Advanced chronic kidney disease in patients undergoing transcatheter aortic valve implantation : Insights on clinical outcomes and prognostic markers froma large cohort of patients. In: European Heart Journal. 2014 ; Vol. 35, No. 38. pp. 2685-2696.
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abstract = "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.",
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author = "Ricardo Allende and Webb, {John G.} and Munoz-Garcia, {Antonio J.} and {De Jaegere}, Peter and Corrado Tamburino and Dager, {Antonio E.} and Asim Cheema and Vicen{\cc} Serra and Ignacio Amat-Santos and Velianou, {James L.} and Marco Barbanti and Danny Dvir and Alonso-Briales, {Juan H.} and Nuis, {Rutger Jan} and Elhamula Faqiri and Sebastiano Imme and Benitez, {Luis Miguel} and Cucalon, {Angela Maria} and {Al Lawati}, Hatim and {Del Blanco}, {Bruno Garcia} and Javier Lopez and Natarajan, {Madhu K.} and Robert DeLarochelli{\`e}re and Marina Urena and Ribeiro, {Henrique B.} and Eric Dumont and Luis Nombela-Franco and Josep Rod{\'e}s-Cabau",
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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

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

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