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Acute kidney injury post-TAVI: does it still impact prognosis?
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 15 - INTELIGÊNCIA ARTIFICIAL EM CARDIOLOGIA: APROVEITAR O POTENCIAL!
Speaker:
Miguel Azaredo Raposo
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Miguel Azaredo Raposo; Catarina Gregório; Ana Abrantes; Daniel Cazeiro; Diogo Ferreira; João Cravo; Marta Vilela; Pedro Carrilho Ferreira; João Silva Marques; Miguel Nobre Menezes; Fausto J. Pinto
Abstract
<p><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Introduction</span></span></strong></span></span></span></p> <div> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">Transcatheter aortic valve implantation (TAVI) procedure has evolved over the years, with reduction of periprocedural complications. Acute kidney injury (AKI) is a frequent complication that affects outcomes and survival. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Aim</span></span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">To determine the incidence of post-TAVI AKI, its predictors and impact on outcomes.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Methods</span></span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">Retrospective single center study, analyzing a population of non-consecutive pts who underwent TAVI in a single center between 2014 and 2023, not previously under dialysis. AKI was defined using AKI Network criteria from stages 0 to 3. Univariate analysis with independent T-student and Chi-square tests was conducted to define associations between baseline characteristics and AKI. Multivariate analysis with logistic regression was conducted to identify predictors of AKI. Kaplan-Meier survival curves were drawn and compared between grades of AKI and hazard ratios were calculated with cox regression. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Results</span></span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">We analyzed a population of 835 patients (pts) with a mean age of 82</span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:black">±</span></span></span><span style="font-size:11pt"><span style="color:black">6,3 years, 54,4% female, with a mean FUP of 39</span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:black">±</span></span></span><span style="font-size:11pt"><span style="color:black">26months. 29% of pts had CKD, 7,2% with severe CKD (stage IV or V).Regarding AKI, 20,8% of pts developed stage 1 AKI; 4,1% stage 2 and 1,9% stage 3. Patients with severe CKD at baseline had a significative association with grade 2 or higher AKI (p <0.01, OR 2,1).</span></span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">There was a significant difference between pts having any degree of post-TAVI AKI and death during FUP ( OR 2.1 [C.I. 1.5-2.8] p<.01).</span></span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">Regarding survival analysis (Fig. 1), there was a 46% increase in hazard for death during mean FUP for patients with any degree of AKI post-TAVI. This increase of hazard is proportional to severity of AKI, being non significative for pts with stage 1 (HR 1.3 p=0.055), 61% increase in hazard for grade 2 AKI and (HR 1.61 p=0.04) and 240% increase in hazard for patients sustaining grade 3 AKI post procedure ( HR 3.4 p<0.01). Pts with an AKI grade 2 or 3 post procedure displayed an odds ratio of 2.7 for death at FUP.</span></span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">On univariate analysis, basal hemoglobin (Hb), post-TAVI Hb drop, baseline creatinine, hypertension and general anesthesia had significant associations with post-procedural grade 2 or 3 AKI. On multivariate analysis, only basal Hb, Hb drop and basal creatinine could predict grade 2 or 3 AKI. Other factor such as contrast volume, procedural time, age and EuroSCORE II had no significant association with AKI.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Conclusions</span></span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">Over 20% of pts develop some degree. AKI is associated with worse outcomes, especially grades 2 and 3, significatively impacting mortality. AKIs etiology is multifactorial, with an interplay of multiple factors which expand well beyond the nephrotoxic insult from contrast. Hemoglobin reduction should be avoided, and special attention should be given for patients with baseline severe CKD.</span></span></span></span></span></p> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div id="accel-snackbar" style="left:50%; top:50px; transform:translate(-50%, 0px)"> </div>
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