Author + information
- Received April 17, 2017
- Revision received June 21, 2017
- Accepted July 19, 2017
- Published online October 16, 2017.
- Tanush Gupta, MDa,
- Kashish Goel, MDb,
- Dhaval Kolte, MD, PhDc,
- Sahil Khera, MD, MPHd,
- Pedro A. Villablanca, MD, MSce,
- Wilbert S. Aronow, MDf,
- Anna E. Bortnick, MD, PhDa,
- David P. Slovut, MD, PhDa,
- Cynthia C. Taub, MDa,
- Jorge R. Kizer, MDa,
- Robert T. Pyo, MDa,
- J. Dawn Abbott, MDc,
- Gregg C. Fonarow, MDg,
- Charanjit S. Rihal, MDb,
- Mario J. Garcia, MDa and
- Deepak L. Bhatt, MD, MPHh,∗ ()
- aDivision of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- bDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- cDivision of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- dDivision of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
- eDivision of Cardiology, New York University Langone Medical Center, New York, New York
- fDivision of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York
- gDivision of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, California
- hBrigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Deepak L. Bhatt, Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115.
Objectives This study sought to determine the association of chronic kidney disease (CKD) with in-hospital outcomes of transcatheter aortic valve replacement (TAVR).
Background CKD is a known independent risk factor for worse outcomes after surgical aortic valve replacement (SAVR). However, data on outcomes of patients with CKD undergoing TAVR are limited, especially in those on chronic dialysis.
Methods The authors used data from the 2012 to 2014 National Inpatient Sample database to identify all patients ≥18 years of age who underwent TAVR. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with no CKD, CKD (without chronic dialysis), or end-stage renal disease (ESRD) on long-term dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in-hospital outcomes.
Results Of 41,025 patients undergoing TAVR from 2012 to 2014, 25,585 (62.4%) had no CKD, 13,750 (33.5%) had CKD, and 1,690 (4.1%) had ESRD. Compared with patients with no CKD, in-hospital mortality was significantly higher in patients with CKD or ESRD (3.8% vs. 4.5% vs. 8.3%; adjusted odds ratio [no CKD as reference]: 1.39 [95% confidence interval: 1.24 to 1.55] for CKD and 2.58 [95% confidence interval: 2.09 to 3.13] for ESRD). Patients with CKD or ESRD had a higher incidence of major adverse cardiovascular events (composite of death, myocardial infarction, or stroke), net adverse cardiovascular events (composite of major adverse cardiovascular events, major bleeding, or vascular complications), and pacemaker implantation compared with patients without CKD. Acute kidney injury (AKI) and AKI requiring dialysis were associated with several-fold higher risk-adjusted in-hospital mortality in patients in the no CKD and CKD groups. Moreover, the incidence of AKI and AKI requiring dialysis did not decline during the study period.
Conclusions Patients with CKD or ESRD have worse in-hospital outcomes after TAVR. AKI is associated with higher in-hospital mortality in patients undergoing TAVR and the incidence of AKI has not declined over the years.
- acute kidney injury
- chronic kidney disease
- end-stage renal disease
- in-hospital mortality
- major adverse cardiovascular event(s)
- transcatheter aortic valve replacement
Dr. Bortnick has received support from the Empire Clinical Research Investigator Program and the National Institutes of Health/National Center for Advancing Translational Science Einstein-Montefiore Clinical and Translation Science Awards (Grant No. UL1TR001073). Dr. Abbott has served as a consulting for Pfizer and Recor. Dr. Fonarow has served as a consultant for Medtronic and St. Jude Medical. Dr. Bhatt has served on the advisory board for Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; has served on the Board of Directors of the Boston VA Research Institute and Society of Cardiovascular Patient Care; has served as the chair of American Heart Association Quality Oversight Committee; has served on the data monitoring committees of the Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute; has received honoraria from the American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), and WebMD (CME steering committees); has served as the Deputy Editor for Clinical Cardiology; has served as the chair of the NCDR-ACTION Registry Steering Committee and VA CART Research and Publications Committee; has received research funding from Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi, and The Medicines Company; has received royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); has served as a site co-investigator for Biotronik, Boston Scientific, and St. Jude Medical (now Abbott); has served as a trustee of American College of Cardiology; and has performed unfunded research for FlowCo, Merck, PLx Pharma, and Takeda. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. A part of this study was presented as an abstract at the American College of Cardiology 66th Annual Scientific Sessions in Washington, DC, on March 18, 2017. Dr. Gupta and Dr. Goel contributed equally to this manuscript.
- Received April 17, 2017.
- Revision received June 21, 2017.
- Accepted July 19, 2017.
- 2017 American College of Cardiology Foundation