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Contrast-Induced Nephropathy in Patients Undergoing Staged Versus Concomitant Transcatheter Aortic Valve Implantation

Gabriele Venturi1, Michele Pighi1, Mattia Lunardi1

  • 1Division of Cardiology Department of Medicine University of Verona Italy.

Journal of the American Heart Association
|July 26, 2021
PubMed

Insights

Performing staged coronary procedures before transcatheter aortic valve implantation (TAVI) significantly increases the risk of contrast-induced acute kidney injury (CI-AKI). A concomitant strategy, combining both procedures, offers a safer approach for renal function in TAVI patients.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Aortic stenosis management often involves transcatheter aortic valve implantation (TAVI).
  • Patients with aortic stenosis frequently have concomitant coronary artery disease requiring intervention.
  • The optimal timing and approach for performing coronary procedures relative to TAVI concerning renal outcomes are not well-defined.

Purpose of the Study:

  • To compare the incidence of contrast-induced acute kidney injury (CI-AKI) between staged and concomitant coronary procedures and TAVI.
  • To evaluate the impact of these strategies on renal function and early safety outcomes.

Main Methods:

  • Retrospective analysis of 339 patients undergoing TAVI with either staged or concomitant coronary procedures.
  • Comparison of CI-AKI rates between the two groups, adjusting for confounders.
  • Assessment of renal function and 30-day safety outcomes.

Main Results:

  • The staged strategy group had a significantly higher incidence of CI-AKI (30.6%) compared to the concomitant strategy group (10.1%).
  • Staged procedures were associated with a nearly fourfold increased risk of CI-AKI, independent of baseline renal function.
  • CI-AKI did not lead to sustained renal injury at 24-month follow-up, and the concomitant strategy did not compromise early safety.

Conclusions:

  • A staged approach for coronary procedures before TAVI is linked to a higher risk of CI-AKI.
  • A concomitant strategy for coronary procedures and TAVI is safer regarding CI-AKI and does not increase overall early complications.

Keywords:
contrast‐induced nephropathycoronary artery diseasetranscatheter aortic valve implantation

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