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
Cardiology Department of the "Rabin Medical Center", Petah Tikva-Israel & "Sackler" school of medicine Tel Aviv University, Tel Aviv, Israel.
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy; Department of Cardiology, Bern University Hospital, Switzerland.
Am J Cardiol. 2017 Dec 1;120(11):2025-2030. doi: 10.1016/j.amjcard.2017.08.020. Epub 2017 Sep 4.
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 m 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.
晚期慢性肾脏病（CKD）是经导管主动脉瓣植入术（TAVI）患者死亡的独立预测因素。我们旨在确定TAVI术后1年死亡率的预测因素，并根据是否存在晚期CKD（定义为估算肾小球滤过率≤30 ml/min/1.73 m²或接受永久性肾脏替代治疗）进行分层。纳入了来自欧洲、日本和以色列10个中心的患者（n = 1204）：464例有晚期CKD，740例无晚期CKD。晚期CKD与校正后1年全因死亡风险增加2倍相关（p <0.001），心血管死亡风险增加1.9倍（p = 0.016）。采用交互项分析来确定和比较两组中1年死亡率的独立预测因素。左心室射血分数降低和功能分级差是晚期CKD组死亡的预测因素（优势比[OR]分别为2.27，p = 0.002和OR 3.87，p = 0.003），但在无晚期CKD的患者中不是（交互作用p值分别为0.035和0.039），而出血是无晚期CKD组死亡的预测因素（OR 3.2，p = 0.005），但在晚期CKD组中不是（交互作用p值 = 0.006）。心房颤动与晚期CKD组心血管死亡风险增加2.2倍相关（p = 0.032），但在无晚期CKD时无此关联（交互作用p值 = 0.022）。总之，晚期CKD与左心室射血分数降低或功能分级差并存对TAVI术后死亡风险有叠加影响。相反，出血对无晚期CKD患者的死亡风险影响更大。
