5 years ago

Predictors of 1-Year Mortality after Transcatheter Aortic Valve Implantation in Patients with and Without Advanced Chronic Kidney Disease

Advanced chronic kidney disease (CKD) is an independent predictor of mortality in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). We aimed to identify predictors of 1-year mortality in post-TAVI patients stratified by the presence or absence of advanced CKD (defined as eGFR ≤30 ml/min/1.73m2 or permanent renal replacement therapy). Patients (n=1204) from 10 centers in Europe, Japan and Israel were included: 464 with and 740 without advanced CKD. Advanced CKD was associated with a 2-fold increase in the adjusted risk of 1-year all-cause death (p<0,001), and a 1.9-fold increase in cardiovascular death (p=0.016). Interaction-term analysis was utilized to identify and compare independent predictors of 1-year mortality in both groups. Impaired Left Ventricular Ejection Fraction (LVEF) and poor functional class (FC) were predictive of death in the advanced CKD group (OR 2.27, p=0.002 and OR 3.87, p=0.003, respectively) but not in patients without advanced CKD (p for interaction = 0.035 and 0.039, respectively), whereas bleeding was a predictor of mortality in the non-advanced CKD group (OR 3.2, p=0.005) but not in advanced CKD (p for interaction = 0.006). Atrial fibrillation was associated with a 2.2-fold increase (p=0.032) in the risk of cardiovascular death in the advanced CKD group but not in the absence of advanced CKD (p for interaction = 0.022). In conclusion, the coexistence of advanced CKD and either reduced LVEF or poor FC has an incremental effect on the risk of death after TAVI. In contrast, bleeding had a greater effect on risk of death in patients without advanced CKD.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917313905

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