Department of Nephrology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Nephrol Dial Transplant. 2020 Mar 1;35(3):433-438. doi: 10.1093/ndt/gfy264.
Acute kidney injury (AKI) complicating transcatheter aortic valve implantation (TAVI) is relatively frequent and associated with significant morbidity. Previous studies have shown a higher 30-day and 1-year mortality risk in patients with periprocedural AKI. Our aim was to identify the prognostic impact of periprocedural AKI on long-term follow-up.
This is a single-center prospective study evaluating patients undergoing TAVI for severe aortic stenosis. AKI was defined according to the Valve Academic Research Consortium 2 definition, as an absolute increase in serum creatinine ≥0.3 mg/dL or an increase >50% within the first week following TAVI. Mortality data were compared between patients who developed AKI and those who did not. Logistic and Cox regressions were used for survival analysis.
The final analysis included 1086 consecutive TAVI patients. AKI occurred in 201 patients (18.5%). During the follow-up period, 289 patients died. AKI was associated with an increased risk of 30-day mortality {4.5 versus 1.9% in the non-AKI group; hazard ratio [HR] 3.70 [95% confidence interval (CI) 1.35-10.13]}. Although 1-year mortality was higher in the AKI group in univariate analysis, it was not significant after a multivariate regression. AKI was a strong predictor of longer-term mortality [42.3 versus 22.7% for 7-year mortality; HR 1.71 (95% CI 1.30-2.25)]. In 189 of 201 patients we had data regarding recovery from AKI up to 30 days after discharge. In patients with recovery from AKI, the mortality rate was lower (38.2 versus 56.6% in the nonrecovery group; P = 0.022).
Periprocedural AKI following TAVI is a strong risk factor for short-term as well as long-term mortality (up to 7 years). Therefore more effort is needed to reduce this complication.
经导管主动脉瓣植入术（TAVI）并发急性肾损伤（AKI）较为常见，且与较高的发病率相关。先前的研究表明，围手术期 AKI 患者的 30 天和 1 年死亡率风险更高。我们的目的是确定围手术期 AKI 对长期随访的预后影响。
这是一项单中心前瞻性研究，评估了因严重主动脉瓣狭窄而行 TAVI 的患者。AKI 根据 Valve Academic Research Consortium 2 定义定义，即 TAVI 后第 1 周内血清肌酐绝对值增加≥0.3mg/dL 或增加>50%。比较发生 AKI 与未发生 AKI 的患者的死亡率数据。逻辑回归和 Cox 回归用于生存分析。
最终分析纳入了 1086 例连续 TAVI 患者。201 例（18.5%）患者发生 AKI。在随访期间，289 例患者死亡。AKI 与 30 天死亡率升高相关{非 AKI 组为 4.5%，AKI 组为 1.9%；危险比[HR]3.70[95%置信区间（CI）1.35-10.13]}。虽然在单变量分析中 AKI 组的 1 年死亡率较高，但在多变量回归后无统计学意义。AKI 是长期死亡率的强烈预测因子[7 年死亡率分别为 42.3%和 22.7%；HR 1.71（95%CI 1.30-2.25)]。在 201 例患者中的 189 例，我们有关于出院后 30 天内 AKI 恢复的数据。在 AKI 恢复的患者中，死亡率较低（非恢复组为 56.6%；P=0.022）。
TAVI 后围手术期 AKI 是短期和长期死亡率（长达 7 年）的强烈危险因素。因此，需要更多努力来减少这种并发症。
