Acute Kidney Injury After Percutaneous Edge-to-Edge Mitral Repair
Por:
Armijo, G, Estevez-Loureiro, R, Carrasco-Chinchilla, F, Arzamendi, D, Fernandez-Vazquez, F, Jimenez-Quevedo, P, Freixa, X, Pascual, I, Serrador, AM, Mesa, D, Alonso-Briales, JH, Goicolea, J, Hernandez-Antolin, R, Fernandez-Peregrina, E, Alvarez, ABC, Andraka, L, Cruz-Gonzalez, I, Berenguer, A, Sanchis, J, Gil, JLD, Hernandez-Garcia, JM, Li, CH, Benito-Gonzalez, T, de Agustin, JA, Avanzas, P, Regueiro, A, Amat-Santos, I, Pan, M, Nombela-Franco, L
Publicada:
24 nov 2020
Resumen:
BACKGROUND In catheter-based procedures, acute kidney injury (AKI) is a frequent, serious complication ranging from 10% to 30%. In MitraClip (Abbott Vascular, Santa Clara, California), a usually contrast-free procedure, there is scarce data about its real incidence and impact.
OBJECTIVES This study aimed to evaluate incidence, predictive factors, and midterm outcomes of AKI in patients with significant mitral regurgitation (MR) undergoing transcatheter valve repair with MitraClip.
METHODS A total of 721 patients undergoing MitraClip were included. AKI was defined as an absolute or a relative increase in serum creatinine of >0.3 mg/dl or >= 50%, respectively, or the need for hemodialysis during index hospitalization.
RESULTS The mean age of the patients was 72 +/- 11 years (28.3% women). Median estimated glomerular filtration rate (eGFR) was 43.7 ml/min/1.73 m(2) (interquartile range: 30.9 to 60.1 ml/min/1.73 m(2)), and was <60 ml/min/1.73 m(2) in 74.9% of the patients. AKI after MitraClip occurred in 106 patients (14.7%). Baseline hemoglobin (<11 g/dl) (odds ratio [OR]: 1.97; p = 0.003), urgent procedure (OR: 3.44; p = 0.003), and absence of device success (OR: 3.37; p < 0.001) were independent predictors of AKI. Patients with AKI had worse outcomes compared to those without AKI, including a higher proportion of in-hospital bleeding events (3.8% vs. 0.8%; p = 0.011), 2-year all-cause mortality (40.5% vs. 18.7%; p < 0.001), and major adverse cardiac events (63.6% vs. 23.5%; p < 0.001). Combination of AKI with significant residual MR after the procedure conferred even worst outcomes (2-year all-cause mortality 50.0% vs. 19.6%; p = 0.001, and major adverse cardiac events 70.0% vs. 18.9%; p < 0.001).
CONCLUSIONS Despite being a "zero-contrast" procedure, one-sixth of patients undergoing transcatheter mitral valve repair had AKI, linked to device failure or other severe conditions. The occurrence of AKI was associated with worse outcomes, highlighting the importance to detect and reduce this complication in high-risk population. (C) 2020 by the American College of Cardiology Foundation.
Filiaciones:
Armijo, G:
Hosp Clin San Carlos, Cardiovasc Inst, IdISSC, C Prof Martin Lagos S-N, Madrid 28040, Spain
Estevez-Loureiro, R:
Hosp Alvaro Cunqueiro, Intervent Cardiol Unit, Vigo, Spain
Carrasco-Chinchilla, F:
Hosp Clin Univ Virgen Victoria, CIBERCV, Malaga, Spain
Arzamendi, D:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Div Intervent Cardiol, Barcelona, Spain
Fernandez-Vazquez, F:
Univ Hosp Leon, Dept Cardiol, Leon, Spain
Jimenez-Quevedo, P:
Hosp Clin San Carlos, Cardiovasc Inst, IdISSC, C Prof Martin Lagos S-N, Madrid 28040, Spain
Freixa, X:
Hosp Clin Barcelona, Cardiovasc Inst, Cardiol Dept, Barcelona, Spain
Univ Barcelona, Barcelona, Spain
Inst Invest Biomed August Pi i Sunyer, Barcelona, Spain
Pascual, I:
Univ Oviedo, Hosp Univ Cent Asturias, Inst Invest Sanitaria Principado Asturias, Heart Area, Asturias, Spain
Serrador, AM:
Hosp Clin Univ Valladolid, Cardiol Dept, CIVERCV, Valladolid, Spain
Mesa, D:
Univ Cordoba, Hosp Reina Sofia, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cardiol Dept, Cordoba, Spain
Alonso-Briales, JH:
Hosp Clin Univ Virgen Victoria, CIBERCV, Malaga, Spain
Goicolea, J:
Hosp Univ Puerta Hierro, Cardiol Dept, Majadahonda, Spain
Hernandez-Antolin, R:
Hosp Univ Ramon y Cajal, Cardiol Dept, Madrid, Spain
Fernandez-Peregrina, E:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Div Intervent Cardiol, Barcelona, Spain
Alvarez, ABC:
Hosp Clin Univ Santiago, CIBERCV, Santiago, Spain
Andraka, L:
Hosp Basurto, Cardiol Dept, Bilbao, Spain
Cruz-Gonzalez, I:
Hosp Clin Univ Salamanca, Ctr Invest Biomed Red Enfermedades Cardiovasc, Inst Invest Biomed Salamanca, Cardiol Dept, Salamanca, Spain
Berenguer, A:
Hosp Gen Univ Valencia, Cardiol Dept, Valencia, Spain
Sanchis, J:
Univ Valencia, Hosp Clin Univ, Cardiol Dept, CIBERCV,INCLIVA, Valencia, Spain
Gil, JLD:
Hosp Univ & Politecn, Cardiol Dept, Valencia, Spain
Hernandez-Garcia, JM:
Hosp Clin Univ Virgen Victoria, CIBERCV, Malaga, Spain
Li, CH:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Div Intervent Cardiol, Barcelona, Spain
Benito-Gonzalez, T:
Univ Hosp Leon, Dept Cardiol, Leon, Spain
de Agustin, JA:
Hosp Clin San Carlos, Cardiovasc Inst, IdISSC, C Prof Martin Lagos S-N, Madrid 28040, Spain
Avanzas, P:
Univ Oviedo, Hosp Univ Cent Asturias, Inst Invest Sanitaria Principado Asturias, Heart Area, Asturias, Spain
Regueiro, A:
Hosp Clin Barcelona, Cardiovasc Inst, Cardiol Dept, Barcelona, Spain
Univ Barcelona, Barcelona, Spain
Inst Invest Biomed August Pi i Sunyer, Barcelona, Spain
Amat-Santos, I:
Hosp Clin Univ Valladolid, Cardiol Dept, CIVERCV, Valladolid, Spain
Pan, M:
Univ Cordoba, Hosp Reina Sofia, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cardiol Dept, Cordoba, Spain
Nombela-Franco, L:
Hosp Clin San Carlos, Cardiovasc Inst, IdISSC, C Prof Martin Lagos S-N, Madrid 28040, Spain
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