Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2019;72:21-9 - Vol. 72 Num.01 DOI: 10.1016/j.rec.2017.11.024

Impact of Acute Kidney Injury on Short- and Long-term Outcomes After Transcatheter Aortic Valve Implantation

Antonio C.B. Nunes Filho a,, Marcelo Katz a, Carlos M. Campos b,c, Luiz A. Carvalho d, Dimytri A. Siqueira e, Rogério T. Tumelero f, Antenor L.F. Portella g, Vinícius Esteves h, Marco A. Perin b, Rogério Sarmento-Leite i, Pedro A. Lemos Neto b,c, Flavio Tarasoutchi b,c, Hiram G. Bezerra j, Fábio S. de Brito b

a Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
b Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
c Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
d Department of Interventional Cardiology, Hospital Pró-Cardíaco, Rio de Janeiro, Brazil
e Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
f Department of Interventional Cardiology, Hospital São Vicente de Paulo, Passo Fundo, Brazil
g Department of Interventional Cardiology, Hospital São Marcos, Teresina, Brazil
h Department of Interventional Cardiology, Rede D’OR São Luiz, São Paulo, Brazil
i Department of Interventional Cardiology, Instituto de Cardiologia, Porto Alegre, Brazil
j Cardiac Catheterization Laboratory, UH Cleveland Medical Center, Cleveland, United States

Keywords

Aortic stenosis. Acute kidney injury. Transcatheter aortic valve implantation. Mortality. Elderly. Valve Academic Research Consortium.

Abstract

Introduction and objectives

Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria.

Methods

Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months.

Results

The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P < .001) and cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively).

Conclusions

Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI.

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1885-5857/© 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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