Abstract
IMPORTANCE The frequency of baseline renal impairment among high-risk and inoperable patients with severe aortic stenosis undergoing a transcatheter aortic valve replacement (TAVR) and the effect of TAVR on subsequent renal function are, to our knowledge, unknown. OBJECTIVE To determine the effect of TAVR among patients with baseline renal impairment. DESIGN, SETTING, AND PARTICIPANTS This substudy of patients with baseline renal impairment (estimated glomerular filtration rate [EGFR]60 mL/min) and paired baseline and 30-day measures of renal function undergoing TAVR in the PARTNER 1 trial and continued access registries was conducted in 25 centers in the United States and Canada. MAIN OUTCOMES AND MEASURES Patientswere categorized with improved EGFR (30-day follow-up EGFR10% higher than baseline pre-TAVR), worsened EGFR (10% lower), or no change in renal function (neither). Baseline characteristics, 30-day to 1-year all-cause mortality, and repeat hospitalization were compared. Multivariable models were constructed to identify predictors of 1-year mortality and of improvement/worsening in EGFR. RESULTS Of the 821 participants,401 (48.8%)werewomen and the mean (SD) age for participants with improved, unchanged, orworsening EGFRwas 84.90(6.91) years, 84.37 (7.13) years, and 85.39 (6.40) years, respectively. The EGFRwas 60mL/min or lower among 821 patients (72%), ofwhom345 (42%) improved, 196 (24%)worsened, and 280 (34%) had no change at 30 days. Therewere no differences in baseline age, body mass index, diabetes, chronic obstructive pulmonary disease, coronary artery disease, peripheral arterial disease, hypertension, pulmonary hypertension, renal or liver disease,NewYork Heart Association III/IV symptoms, transaortic gradient, left ventricular ejection fraction, or procedural characteristics. The group with improved EGFR had morewomen, nonsmokers, and a lower cardiac index. Those with worsening EGFR had a higher median Society of Thoracic Surgeons score and left ventricle mass. From 30 days to 1 year, those with improved EGFR had no difference in mortality or repeat hospitalization. Those withworsening EGFR had increased mortality (25.5%vs 19.1%, P = .07) but no significant increases in repeat hospitalization or dialysis. Predictors of improved EGFRwere being female (odds ratio [OR], 1.38; 95%CI, 1.03-1.85; P = .03) and nonsmoking status (OR, 1.49; 95%CI, 1.11-1.01; P = .01); predictors ofworsening EGFRwere baseline left ventricle mass (OR, 1.00; 95%CI, 1.00-1.01; P = .01), smoking (OR, 1.51; 95%CI, 1.06-2.14; P = .02), and age (OR, 1.03; 95%CI, 1.00-1.05; P = .05); and predictors of 1-year mortalitywere baseline left ventricular ejection fraction (OR,0.98; 95%CI,0.97-0.99; P = .003), baseline EGFR (OR,0.98; 95%CI,0.96-0.99; P < .001), andworsening EGFR vs no change in EGFR (OR, 1.51; 95%CI, 1.02-2.24; P = .04). CONCLUSIONS AND RELEVANCE Baseline renal impairment was frequent among patients who underwent TAVR. While improved EGFR did not improve 1-year outcomes, worsening EGFR was associated with increased mortality.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 742-749 |
| Number of pages | 8 |
| Journal | JAMA cardiology |
| Volume | 2 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2017 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
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Association of transcatheter aortic valve replacement with 30-day renal function and 1-year outcomes among patients presenting with compromised baseline renal function experience from the PARTNER 1 trial and registry. / Beohar, Nirat; Doshi, Darshan; Thourani, Vinod; Jensen, Hanna; Kodali, Susheel; Zhang, Feifan; Zhang, Yiran; Davidson, Charles; McCarthy, Patrick; Mack, Michael; Kapadia, Samir; Leon, Martin; Kirtane, Ajay.
In: JAMA cardiology, Vol. 2, No. 7, 07.2017, p. 742-749.Research output: Contribution to journal › Article
TY - JOUR
T1 - Association of transcatheter aortic valve replacement with 30-day renal function and 1-year outcomes among patients presenting with compromised baseline renal function experience from the PARTNER 1 trial and registry
AU - Beohar, Nirat
AU - Doshi, Darshan
AU - Thourani, Vinod
AU - Jensen, Hanna
AU - Kodali, Susheel
AU - Zhang, Feifan
AU - Zhang, Yiran
AU - Davidson, Charles
AU - McCarthy, Patrick
AU - Mack, Michael
AU - Kapadia, Samir
AU - Leon, Martin
AU - Kirtane, Ajay
PY - 2017/7
Y1 - 2017/7
N2 - IMPORTANCE The frequency of baseline renal impairment among high-risk and inoperable patients with severe aortic stenosis undergoing a transcatheter aortic valve replacement (TAVR) and the effect of TAVR on subsequent renal function are, to our knowledge, unknown. OBJECTIVE To determine the effect of TAVR among patients with baseline renal impairment. DESIGN, SETTING, AND PARTICIPANTS This substudy of patients with baseline renal impairment (estimated glomerular filtration rate [EGFR]60 mL/min) and paired baseline and 30-day measures of renal function undergoing TAVR in the PARTNER 1 trial and continued access registries was conducted in 25 centers in the United States and Canada. MAIN OUTCOMES AND MEASURES Patientswere categorized with improved EGFR (30-day follow-up EGFR10% higher than baseline pre-TAVR), worsened EGFR (10% lower), or no change in renal function (neither). Baseline characteristics, 30-day to 1-year all-cause mortality, and repeat hospitalization were compared. Multivariable models were constructed to identify predictors of 1-year mortality and of improvement/worsening in EGFR. RESULTS Of the 821 participants,401 (48.8%)werewomen and the mean (SD) age for participants with improved, unchanged, orworsening EGFRwas 84.90(6.91) years, 84.37 (7.13) years, and 85.39 (6.40) years, respectively. The EGFRwas 60mL/min or lower among 821 patients (72%), ofwhom345 (42%) improved, 196 (24%)worsened, and 280 (34%) had no change at 30 days. Therewere no differences in baseline age, body mass index, diabetes, chronic obstructive pulmonary disease, coronary artery disease, peripheral arterial disease, hypertension, pulmonary hypertension, renal or liver disease,NewYork Heart Association III/IV symptoms, transaortic gradient, left ventricular ejection fraction, or procedural characteristics. The group with improved EGFR had morewomen, nonsmokers, and a lower cardiac index. Those with worsening EGFR had a higher median Society of Thoracic Surgeons score and left ventricle mass. From 30 days to 1 year, those with improved EGFR had no difference in mortality or repeat hospitalization. Those withworsening EGFR had increased mortality (25.5%vs 19.1%, P = .07) but no significant increases in repeat hospitalization or dialysis. Predictors of improved EGFRwere being female (odds ratio [OR], 1.38; 95%CI, 1.03-1.85; P = .03) and nonsmoking status (OR, 1.49; 95%CI, 1.11-1.01; P = .01); predictors ofworsening EGFRwere baseline left ventricle mass (OR, 1.00; 95%CI, 1.00-1.01; P = .01), smoking (OR, 1.51; 95%CI, 1.06-2.14; P = .02), and age (OR, 1.03; 95%CI, 1.00-1.05; P = .05); and predictors of 1-year mortalitywere baseline left ventricular ejection fraction (OR,0.98; 95%CI,0.97-0.99; P = .003), baseline EGFR (OR,0.98; 95%CI,0.96-0.99; P < .001), andworsening EGFR vs no change in EGFR (OR, 1.51; 95%CI, 1.02-2.24; P = .04). CONCLUSIONS AND RELEVANCE Baseline renal impairment was frequent among patients who underwent TAVR. While improved EGFR did not improve 1-year outcomes, worsening EGFR was associated with increased mortality.
AB - IMPORTANCE The frequency of baseline renal impairment among high-risk and inoperable patients with severe aortic stenosis undergoing a transcatheter aortic valve replacement (TAVR) and the effect of TAVR on subsequent renal function are, to our knowledge, unknown. OBJECTIVE To determine the effect of TAVR among patients with baseline renal impairment. DESIGN, SETTING, AND PARTICIPANTS This substudy of patients with baseline renal impairment (estimated glomerular filtration rate [EGFR]60 mL/min) and paired baseline and 30-day measures of renal function undergoing TAVR in the PARTNER 1 trial and continued access registries was conducted in 25 centers in the United States and Canada. MAIN OUTCOMES AND MEASURES Patientswere categorized with improved EGFR (30-day follow-up EGFR10% higher than baseline pre-TAVR), worsened EGFR (10% lower), or no change in renal function (neither). Baseline characteristics, 30-day to 1-year all-cause mortality, and repeat hospitalization were compared. Multivariable models were constructed to identify predictors of 1-year mortality and of improvement/worsening in EGFR. RESULTS Of the 821 participants,401 (48.8%)werewomen and the mean (SD) age for participants with improved, unchanged, orworsening EGFRwas 84.90(6.91) years, 84.37 (7.13) years, and 85.39 (6.40) years, respectively. The EGFRwas 60mL/min or lower among 821 patients (72%), ofwhom345 (42%) improved, 196 (24%)worsened, and 280 (34%) had no change at 30 days. Therewere no differences in baseline age, body mass index, diabetes, chronic obstructive pulmonary disease, coronary artery disease, peripheral arterial disease, hypertension, pulmonary hypertension, renal or liver disease,NewYork Heart Association III/IV symptoms, transaortic gradient, left ventricular ejection fraction, or procedural characteristics. The group with improved EGFR had morewomen, nonsmokers, and a lower cardiac index. Those with worsening EGFR had a higher median Society of Thoracic Surgeons score and left ventricle mass. From 30 days to 1 year, those with improved EGFR had no difference in mortality or repeat hospitalization. Those withworsening EGFR had increased mortality (25.5%vs 19.1%, P = .07) but no significant increases in repeat hospitalization or dialysis. Predictors of improved EGFRwere being female (odds ratio [OR], 1.38; 95%CI, 1.03-1.85; P = .03) and nonsmoking status (OR, 1.49; 95%CI, 1.11-1.01; P = .01); predictors ofworsening EGFRwere baseline left ventricle mass (OR, 1.00; 95%CI, 1.00-1.01; P = .01), smoking (OR, 1.51; 95%CI, 1.06-2.14; P = .02), and age (OR, 1.03; 95%CI, 1.00-1.05; P = .05); and predictors of 1-year mortalitywere baseline left ventricular ejection fraction (OR,0.98; 95%CI,0.97-0.99; P = .003), baseline EGFR (OR,0.98; 95%CI,0.96-0.99; P < .001), andworsening EGFR vs no change in EGFR (OR, 1.51; 95%CI, 1.02-2.24; P = .04). CONCLUSIONS AND RELEVANCE Baseline renal impairment was frequent among patients who underwent TAVR. While improved EGFR did not improve 1-year outcomes, worsening EGFR was associated with increased mortality.
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UR - http://www.scopus.com/inward/citedby.url?scp=85031705553&partnerID=8YFLogxK
U2 - 10.1001/jamacardio.2017.1220
DO - 10.1001/jamacardio.2017.1220
M3 - Article
C2 - 28467527
AN - SCOPUS:85031705553
VL - 2
SP - 742
EP - 749
JO - JAMA Cardiology
JF - JAMA Cardiology
SN - 2380-6583
IS - 7
ER -