Elsevier

The American Journal of Cardiology

Volume 133, 15 October 2020, Pages 89-97
The American Journal of Cardiology

Late Adverse Cardiorenal Events of Catheter Procedure-Related Acute Kidney Injury After Transcatheter Aortic Valve Implantation

https://doi.org/10.1016/j.amjcard.2020.07.041Get rights and content

Data regarding the longitudinal effect of catheter procedure-related acute kidney injury (AKI) on clinical outcomes are limited. This study aimed to assess the late adverse cardiorenal events of AKI following transcatheter aortic valve implantation (TAVI). A total of 2,518 patients who underwent TAVI, excluding in-hospital deaths, were enrolled from the Japanese multicenter registry. The definition of AKI was determined using the Valve Academic Research Consortium-2 criteria. The incidence, predictors, major adverse renal and cardiac events (MARCE), and all-cause mortality of AKI were evaluated. MARCE included readmission for renal and heart failure (HF), hemodialysis requirement, and cardiovascular-renal death during the follow-up period. The incidence of AKI was 9.7% in the entire cohort. The significant predictive factors of AKI were men, diabetes mellitus, hypertension, chronic kidney disease, low albumin, overdose of contrast media, nontransfemoral approach, transfusion, vascular complications, and new pacemaker implantation. The rates of HF readmission and future hemodialysis were significantly higher in patients with AKI than in those without AKI (19.7% vs 9.0%, p <0.001, 3.3% vs 0.4%, p <0.001, respectively). Cox regression multivariate analysis showed that AKI occurrence was an independent predictive factor for the incremental risk of both MARCE and late mortality up to 4 years (hazard ratio [HR] 1.59, 95% confidence interval [CI] 0.75 to 1.20, p <0.001, HR 2.18, 95% CI 1.70 to 2.79; p <0.001, respectively). In conclusion, AKI occurrence was significantly associated with late adverse cardiorenal events after TAVI. Adequate clinical management can be expected to reduce AKI-related late phase cardiorenal damage even after successful TAVI.

Section snippets

Methods

Data were extracted from the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI registry.12, 13 The OCEAN-TAVI registry is an ongoing multicenter registry collecting data from 14 Japanese medical centers including Kishiwada Tokusyukai Hospital.12, 13 A total of 2,588 patients underwent baseline, peri-, and postoperative data collection before undergoing TAVI between October 2013 and May 2017. All patients who underwent TAVI in each center were considered in the initial inclusion in this

Results

AKI occurred in 243 of 2,518 patients (9.7%). The patient baseline characteristics are shown in Table 1. The proportion of men patients was 30.5%, and the mean age was 84.3 ± 5.2 years. Several baseline characteristics differed between the AKI and non-AKI groups. The baseline SCr value was higher and eGFR was lower in the AKI group than in the non-AKI group (1.39 ± 0.8 mg/dl vs 0.99 ± 0.4 mg/dl, p <0.001, 51.6 ± 19.4 ml/min/1.73 m2 vs 52.7 ± 19.1 ml/min/1.73 m2, p = 0.04, respectively). As a

Discussion

The results of our study demonstrated the clinical impact of AKI on the long-term cardiac adverse events after TAVI. Although the longitudinal clinical effect of catheter-related AKI has not been well established, the occurrence of AKI significantly increased the rates of HF readmission, future hemodialysis, cardiac death, and all-cause mortality. AKI-related complications negatively affect both cardiac and renal function; this supports the concept of cardiorenal syndrome.10, 11 Even after a

Authors’ Contributions

Yuya Adachi: Conceptualization, Methodology, Software, Formal analysis, Visualization. Masanori Yamamoto: Data curation, Writing - Review and Editing, Supervision. Tetsuro Shimura: Resources, Data curation. Ryo Yamaguchi: Resources, Data curation. Ai Kagase: Resources, Data curation. Takahiro Tokuda: Resources, Data curation. Satoshi Tsujimoto: Resources, Data curation. Yutaka Koyama: Resources, Data curation. Toshiaki Otsuka: Software, Validation, Formal analysis. Fumiaki Yashima:

Disclosures

Drs. Yamamoto, Tada, Naganuma, Shirai, Mizutani, and Watanabe are clinical proctors for Edwards Lifesciences and Medtronic. Drs. Araki, Tabata, Takagi, Higashimori, and Hayashida are clinical proctors of Edwards Lifesciences. Dr. Ueno is a clinical proctor for Medtronic. The remaining authors have nothing to disclose.

Acknowledgment

The authors thank the investigators and institutions that have participated in the OCEAN-TAVI registry.

References (19)

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Funding: The OCEAN-TAVI registry is supported by Edwards Lifesciences, Medtronic, and Daiichi-Sankyo Company.

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