Oguri Atsushi, Yamamoto Masanori, Mouillet Gauthier, Gilard Martine, Laskar Marc, Eltchaninoff Helene, Fajadet Jean, Iung Bernard, Donzeau-Gouge Patrick, Leprince Pascal, Leguerrier Alain, Prat Alain, Lievre Michel, Chevreul Karine, Dubois-Rande Jean-Luc, Teiger Emmanuel
Centre Hospitalier Universitaire (CHU) Henri Mondor, Créteil, France.
EuroIntervention. 2015 Jan;10(9):e1-9. doi: 10.4244/EIJV10I9A183.
The aim of this study was to assess the influence of chronic kidney disease (CKD) classification on clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI).
Data of 2,929 consecutive patients undergoing TAVI in the FRANCE 2 registry were analysed. Patients were divided into five groups: CKD 1+2, 3a, 3b, 4, and 5. Both 30-day and one-year mortality rates were significantly increased and positively correlated with CKD severity in all groups. After adjusting for significant influential confounders in a Cox regression multivariate model, CKD 4 and 5 were associated with increased risk of both 30-day mortality and one-year mortality when compared with CKD 1+2 as the reference. This higher mortality was predominantly driven by renal failure and infection in patients with CKD 4 and 5, respectively. Procedural success rate in CKD 5 was significantly lower than that in other groups. All CKD patients trended towards a higher incidence of acute kidney injury (AKI), in parallel with the degree of CKD severity.
Classification of CKD stages before TAVI allows risk stratification for 30-day and one-year clinical outcomes. CKD 3b, 4 and 5 correlate with poor outcome and are considered a significant risk for TAVI.
本研究旨在评估慢性肾脏病（CKD）分类对接受经导管主动脉瓣植入术（TAVI）患者临床结局的影响。
对法国2注册研究中2929例连续接受TAVI的患者数据进行分析。患者分为五组：CKD 1+2、3a、3b、4和5。所有组的30天和1年死亡率均显著升高，且与CKD严重程度呈正相关。在Cox回归多变量模型中对显著影响的混杂因素进行校正后，与以CKD 1+2为参照相比，CKD 4和5与30天死亡率和1年死亡率风险增加相关。这种较高的死亡率在CKD 4和5患者中分别主要由肾衰竭和感染导致。CKD 5组的手术成功率显著低于其他组。所有CKD患者急性肾损伤（AKI）发生率均有升高趋势，且与CKD严重程度相关。
TAVI术前对CKD阶段进行分类可对30天和1年临床结局进行风险分层。CKD 3b、4和5与不良结局相关，被认为是TAVI的重大风险因素。
