• Rev Esp Cardiol (Engl Ed) · Jan 2019

    Multicenter Study

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

    • Antonio C B Nunes Filho, Marcelo Katz, Carlos M Campos, Luiz A Carvalho, Dimytri A Siqueira, Rogério T Tumelero, Antenor L F Portella, Vinícius Esteves, Marco A Perin, Rogério Sarmento-Leite, Pedro A Lemos Neto, Flavio Tarasoutchi, Hiram G Bezerra, and Fábio S de Brito.
    • Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: antonio.filho@einstein.br.
    • Rev Esp Cardiol (Engl Ed). 2019 Jan 1; 72 (1): 21-29.

    Introduction And ObjectivesAcute 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.MethodsConsecutive 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.ResultsThe 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).ConclusionsAcute 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.Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

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