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Prognostic value of chronic kidney disease after transcatheter aortic valve implantation
Masanori Yamamoto1, Kentaro Hayashida, Gauthier Mouillet
1Department of Interventional Cardiology, AP-HP, Henri Mondor University Hospital, Créteil, France.
Insights
Chronic kidney disease (CKD) classification significantly impacts outcomes after transcatheter aortic valve implantation (TAVI). Advanced CKD stages, particularly stage 4, are linked to higher mortality rates post-TAVI.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Impaired renal function is a known risk factor in cardiovascular procedures.
- The prognostic impact of chronic kidney disease (CKD) classification on outcomes following transcatheter aortic valve implantation (TAVI) in elderly patients remains underexplored.
Purpose of the Study:
- To evaluate how different stages of CKD influence clinical outcomes in patients undergoing TAVI.
- To determine the prognostic value of CKD classification in a cohort of very elderly TAVI patients.
Main Methods:
- Prospective data collection from 642 consecutive patients undergoing TAVI.
- Patients were stratified into CKD stages 1+2, 3a, 3b, and 4 based on estimated glomerular filtration rate (eGFR).
- Clinical outcomes, including 30-day and 1-year mortality, were compared across CKD groups.
Main Results:
- Mortality rates at 30 days and 1 year significantly increased with higher CKD stages (p < 0.001).
- CKD stage 4 was independently associated with increased 30-day mortality (HR: 3.04; p = 0.004).
- CKD stages 3b and 4 were associated with increased 1-year mortality (HRs: 1.71 and 2.91, respectively; p < 0.020).
Conclusions:
- Pre-procedural CKD classification effectively stratifies risk for early and midterm outcomes in TAVI patients.
- TAVI in patients with CKD stage 4 presents significant challenges due to elevated post-procedural mortality rates.
Objectives:
This study sought to assess the influence of chronic kidney disease (CKD) classification on clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI).
Background:
The prognostic value of impaired renal function according to CKD classification has not been thoroughly investigated in very elderly TAVI cohorts.
Methods:
Data from 642 consecutive patients who underwent TAVI were prospectively collected. Clinical outcomes were compared in enrolled patients, divided into CKD stage 1+2, CKD stage 3a, CKD stage 3b, and CKD stage 4 on the basis of estimated glomerular filtration rate ≥60, 45 to 59, 30 to 44, and 15 to 29 ml/min/1.73 m(2), respectively.
Results:
Among the study patients (mean age: 83.5 ± 6.5 years, logistic European System for Cardiac Operative Risk Evaluation score 20.0% [range: 13.6% to 28.8%]), 34% were categorized as CKD stage 1+2 (n = 218), 28.3% as CKD stage 3a (n = 182), 28.2% as CKD stage 3b (n = 181), and 9.5% as CKD stage 4 (n = 61). Thirty-day and cumulative 1-year mortality rates increased significantly across the 4 groups (6.9% vs. 8.8% vs. 13.3% vs. 26.2%, p = 0.002, and 17.2% vs. 23.4% vs. 29.2% vs. 47.8%, p < 0.001, respectively). After adjustment for considerable influential confounders in a Cox multivariate regression model, CKD stage 4 was associated with increased risk for 30-day mortality (hazard ratio: 3.04; 95% confidence interval [CI]: 1.43 to 6.49; p = 0.004), and CKD stages 3b and 4 were related to increased cumulative 1-year mortality (hazard ratios: 1.71 and 2.91; 95% CI: 1.09 to 2.68 and 1.73 to 4.90; p = 0.020 and p < 0.001, respectively) compared with CKD stage 1+2 as the referent.
Conclusions:
Classification of CKD stages before TAVI allows risk stratification for early and midterm clinical outcomes. TAVI for patients with CKD stage 4 is still considered challenging because of high mortality rates after the procedure.
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