Author + information
- Received September 11, 2017
- Revision received March 5, 2018
- Accepted March 13, 2018
- Published online June 4, 2018.
- Luis Nombela-Franco, MD, PhDa,∗ (, )
- Josep Rodés-Cabau, MDb,
- Ignacio Cruz-Gonzalez, MD, PhDc,
- Xavier Freixa, MD, PhDd,
- Luis Asmarats, MDe,
- Hipólito Gutiérrez, MDf,
- Shweta Sahay, MDa,
- Tania Rodriguez-Gabella, MDb,
- Jose Carlos Moreno-Samos, MDc,
- Gabriela Tirado-Conte, MDa,
- Luis Renier Goncalves-Ramirez, MDf,
- Juan Carlos Rama-Merchan, MD, PhDc,
- Ignacio J. Amat-Santos, MD, PhDf,
- Gilles O’Hara, MDb,
- Victoria Martín-Yuste, MDd,
- Armando Bethencourt, MD, PhDe,
- Pilar Jimenez-Quevedo, MD, PhDa and
- Carlos Macaya, MD, PhDa
- aInstituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- bQuebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
- cCardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca, CIBER-CV, Salamanca, Spain
- dDepartment of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
- eHospital Universitari Son Espases, Palma, Balearic Islands, Spain
- fInstitute of Heart Sciences, Hospital Clínico Universitario of Valladolid, Valladolid, Spain
- ↵∗Address for correspondence:
Dr. Luis Nombela-Franco, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, C/Prof. Martin Lagos s/n, 28040 Madrid, Spain.
Objectives The aims of this registry were to determine the incidence, predictors, and prognostic value of periprocedural acute kidney injury (AKI) after left atrial appendage closure (LAAC).
Background No data exist on the occurrence of AKI after LAAC.
Methods A total of 355 patients undergoing LAAC were included in the study. AKI was defined as an absolute or a relative increase in serum creatinine of >0.3 mg/dl or ≥50%, respectively, after the procedure or the need for hemodialysis during index hospitalization.
Results The incidence of AKI was 9%, and patients with worse baseline renal function were at higher risk for developing AKI (odds ratio: 1.32; 95% confidence interval [CI]: 1.09 to 1.61; p = 0.004 for each 10 ml/min decrease in glomerular filtration rate). In-hospital bleeding events occurred more frequently in the AKI group (5.3% vs. 15.6%; p = 0.037). After a median follow-up period of 18 months, patients in the AKI group had higher mortality (hazard ratio [HR]: 2.59; 95% CI: 1.36 to 4.92; p = 0.004), more embolic events (HR: 6.14; 95% CI: 2.23 to 16.92; p = 0.001) and major bleeding events (HR: 2.36; 95% CI: 0.89 to 6.24; p = 0.083). The occurrence of AKI was an independent predictor of midterm mortality (HR: 2.00; 95% CI: 1.02 to 3.91; p = 0.044).
Conclusions The occurrence of AKI was relatively frequent following LAAC, and patients with lower renal glomerular filtration rates were at high risk for developing this complication. AKI identified a group of patients with worse midterm outcomes, highlighting the importance of further preventive strategies in this population.
Drs. Nombela-Franco, Rodés-Cabau, Cruz-Gonzalez, Freixa, and Bethencourt have served as proctors for Abbott. Dr. Cruz-Gonzalez has served as a proctor for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 11, 2017.
- Revision received March 5, 2018.
- Accepted March 13, 2018.
- 2018 American College of Cardiology Foundation