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

Amos Levi, Pablo Codner, Amer Masalha, Giuseppe Gargiulo, Fabien Praz, Kentaro Hayashida, Yusuke Watanabe, Darren Mylotte, Nicolas Debry, Marco Barbanti, Thierry Lefèvre, Thomas Modine, Johan Bosmans, Stephan Windecker, Israel Barbash, Jan Malte Sinning, Georg Nickenig, Alon Barsheshet, Ran Kornowski

Research output: Contribution to journalArticle

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Abstract

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 patients after TAVI stratified by the presence or absence of advanced CKD (defined as estimated glomerular filtration rate ≤30 ml/min/1.73 m2 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 used to identify and compare independent predictors of 1-year mortality in both groups. Impaired left ventricular ejection fraction and poor functional class were predictive of death in the advanced CKD group (odds ratio [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 nonadvanced 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 left ventricular ejection fraction or poor functional class 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.

Original languageEnglish
JournalAmerican Journal of Cardiology
DOIs
Publication statusAccepted/In press - 2017

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Chronic Renal Insufficiency
Mortality
Odds Ratio
Stroke Volume
Transcatheter Aortic Valve Replacement
Hemorrhage
Renal Replacement Therapy
Israel
Glomerular Filtration Rate
Atrial Fibrillation
Cause of Death
Japan

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predictors of 1-Year Mortality After Transcatheter Aortic Valve Implantation in Patients With and Without Advanced Chronic Kidney Disease. / Levi, Amos; Codner, Pablo; Masalha, Amer; Gargiulo, Giuseppe; Praz, Fabien; Hayashida, Kentaro; Watanabe, Yusuke; Mylotte, Darren; Debry, Nicolas; Barbanti, Marco; Lefèvre, Thierry; Modine, Thomas; Bosmans, Johan; Windecker, Stephan; Barbash, Israel; Sinning, Jan Malte; Nickenig, Georg; Barsheshet, Alon; Kornowski, Ran.

In: American Journal of Cardiology, 2017.

Research output: Contribution to journalArticle

Levi, A, Codner, P, Masalha, A, Gargiulo, G, Praz, F, Hayashida, K, Watanabe, Y, Mylotte, D, Debry, N, Barbanti, M, Lefèvre, T, Modine, T, Bosmans, J, Windecker, S, Barbash, I, Sinning, JM, Nickenig, G, Barsheshet, A & Kornowski, R 2017, 'Predictors of 1-Year Mortality After Transcatheter Aortic Valve Implantation in Patients With and Without Advanced Chronic Kidney Disease', American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2017.08.020
Levi, Amos ; Codner, Pablo ; Masalha, Amer ; Gargiulo, Giuseppe ; Praz, Fabien ; Hayashida, Kentaro ; Watanabe, Yusuke ; Mylotte, Darren ; Debry, Nicolas ; Barbanti, Marco ; Lefèvre, Thierry ; Modine, Thomas ; Bosmans, Johan ; Windecker, Stephan ; Barbash, Israel ; Sinning, Jan Malte ; Nickenig, Georg ; Barsheshet, Alon ; Kornowski, Ran. / Predictors of 1-Year Mortality After Transcatheter Aortic Valve Implantation in Patients With and Without Advanced Chronic Kidney Disease. In: American Journal of Cardiology. 2017.
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abstract = "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 patients after TAVI stratified by the presence or absence of advanced CKD (defined as estimated glomerular filtration rate ≤30 ml/min/1.73 m2 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 used to identify and compare independent predictors of 1-year mortality in both groups. Impaired left ventricular ejection fraction and poor functional class were predictive of death in the advanced CKD group (odds ratio [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 nonadvanced 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 left ventricular ejection fraction or poor functional class 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.",
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AU - Levi, Amos

AU - Codner, Pablo

AU - Masalha, Amer

AU - Gargiulo, Giuseppe

AU - Praz, Fabien

AU - Hayashida, Kentaro

AU - Watanabe, Yusuke

AU - Mylotte, Darren

AU - Debry, Nicolas

AU - Barbanti, Marco

AU - Lefèvre, Thierry

AU - Modine, Thomas

AU - Bosmans, Johan

AU - Windecker, Stephan

AU - Barbash, Israel

AU - Sinning, Jan Malte

AU - Nickenig, Georg

AU - Barsheshet, Alon

AU - Kornowski, Ran

PY - 2017

Y1 - 2017

N2 - 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 patients after TAVI stratified by the presence or absence of advanced CKD (defined as estimated glomerular filtration rate ≤30 ml/min/1.73 m2 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 used to identify and compare independent predictors of 1-year mortality in both groups. Impaired left ventricular ejection fraction and poor functional class were predictive of death in the advanced CKD group (odds ratio [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 nonadvanced 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 left ventricular ejection fraction or poor functional class 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.

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