Michael E. DeBakey VA Medical Center, Section of Cardiology, Baylor College of Medicine, Houston, Texas.
Section of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
Am J Cardiol. 2022 Feb 1;164:100-102. doi: 10.1016/j.amjcard.2021.10.039. Epub 2021 Nov 23.
Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are at higher risk of aortic stenosis. Data regarding transcatheter aortic valve implantation (TAVI) in these patients are limited. Herein, we aim to investigate TAVI outcomes in patients with ESKD and CKD. We analyzed clinical data of patients with ESKD and CKD who underwent TAVI from 2008 to 2018 in a large urban healthcare system. Patients' demographics were compared, and significant morbidity and mortality outcomes were noted. Multivariable analyses were used to adjust for potential baseline variables. A total of 643 patients with CKD underwent TAVI with an overall in-hospital mortality of 5.1%, whereas 84 patients with ESKD underwent TAVI with an overall mortality rate of 11.9%. The most frequently observed comorbidities in patients with CKD were heart failure, atrial fibrillation (AF), mitral stenosis (MS), pulmonary hypertension, and chronic lung disease. After multivariable analysis, MS (adjusted odds ratio (OR) 3.92; 95% confidence interval (CI) 1.09 to 11.1, p <0.05) and AF (adjusted OR 2.42; 95% CI 1.3 to 4.4 p <0.05) were independently associated with mortality in patients with CKD. The most common comorbidities observed in patients with ESKD undergoing TAVI were heart failure, chronic lung disease, AF, MS, and pulmonary hypertension. An association between MS and increased mortality was observed (adjusted OR 2.01; 95 CI 0.93 to 2.02, p = 0.09) in patients with ESKD, but was not statistically significant. In conclusion, in patients with CKD undergoing TAVI, AF and MS were independently associated with increased mortality.
患有慢性肾脏病 (CKD) 和终末期肾病 (ESKD) 的患者发生主动脉瓣狭窄的风险较高。关于这些患者行经导管主动脉瓣植入术 (TAVI) 的数据有限。在此，我们旨在研究 ESKD 和 CKD 患者的 TAVI 结果。我们分析了在一个大型城市医疗保健系统中接受 TAVI 的 ESKD 和 CKD 患者的临床数据。比较了患者的人口统计学数据，并记录了显著的发病率和死亡率结果。使用多变量分析来调整潜在的基线变量。共有 643 例 CKD 患者接受了 TAVI，住院总死亡率为 5.1%，而 84 例 ESKD 患者接受了 TAVI，总死亡率为 11.9%。CKD 患者最常见的合并症有心衰、心房颤动 (AF)、二尖瓣狭窄 (MS)、肺动脉高压和慢性肺部疾病。多变量分析后，MS（调整后的优势比 (OR) 3.92；95%置信区间 (CI) 1.09 至 11.1，p <0.05）和 AF（调整后的 OR 2.42；95% CI 1.3 至 4.4，p <0.05）与 CKD 患者的死亡率独立相关。接受 TAVI 的 ESKD 患者最常见的合并症有心衰、慢性肺部疾病、AF、MS 和肺动脉高压。观察到 MS 与死亡率增加之间存在关联（调整后的 OR 2.01；95%CI 0.93 至 2.02，p = 0.09），但无统计学意义。总之，在接受 TAVI 的 CKD 患者中，AF 和 MS 与死亡率增加独立相关。
