Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement

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[Released on 04/04/2024]

Authors: Vincenzo Pasceri MD, PhD , Francesco Pelliccia MD, PhD , Roxana Mehran MD, PhD , George Dangas MD, PhD , Italo Porto MD, PhD , Francesco Radico MD, PhD , Fausto Biancari MD, PhD , Fabrizio D'Ascenzo MD, PhD , Francesco Saia MD, PhD , Giampaolo Luzi MD , Francesco Bedogni MD , Ignacio J. Amat Santos MD, PhD , Vincenzo De Marzo MD , Arnaldo Dimagli MD , Timo Mäkikallio MD, PhD , Eugenio Stabile MD, PhD , Sara Blasco‐Turrión MD, PhD , Luca Testa MD, PhD , Marco Barbanti MD, PhD , Corrado Tamburino MD, PhD , Franco Fabiocchi MD, PhD , Ahmed Chilmeran MD , Federico Conrotto MD, PhD , Giuliano Costa MD, PhD , Giulio Stefanini MD, PhD , Carmen Spaccarotella MD , Andrea Macchione MD , Michele La Torre MD , Francesco Bendandi MD , Tatu Juvonen MD, PhD , Wojciech Wańha MD , Wojtek Wojakowski MD , Umberto Benedetto MD, PhD , Ciro Indolfi MD, PhD , David Hildick‐Smith MD, PhD , Marco Zimarino MD, PhD

Abstract

Background Dialysis is a rare but serious complication after transcatheter aortic valve replacement. We analyzed the large multicenter TRITAVI (transfusion requirements in transcatheter aortic valve implantation) registry in order to develop and validate a clinical score assessing this risk.
Methods and Results A total of 10 071 consecutive patients were enrolled in 19 European centers. Patients were randomly assigned (2:1) to a derivation and validation cohort. Two scores were developed, 1 including only preprocedural variables (TRITAVIpre) and 1 also including procedural variables (TRITAVIpost). In the 6714 patients of the derivation cohort (age 82±6 years, 48% men), preprocedural factors independently associated with dialysis and included in the TRITAVIpre score were male sex, diabetes, prior coronary artery bypass graft, anemia, nonfemoral access, and creatinine clearance <30 mL/min per m2. Additional independent predictors among procedural features were volume of contrast, need for transfusion, and major vascular complications. Both scores showed a good discrimination power for identifying risk for dialysis with C‐statistic 0.78 for TRITAVIpre and C‐statistic 0.88 for TRITAVIpost score. Need for dialysis increased from the lowest to the highest of 3 risk score groups (from 0.3% to 3.9% for TRITAVIpre score and from 0.1% to 6.2% for TRITAVIpost score). Analysis of the 3357 patients of the validation cohort (age 82±7 years, 48% men) confirmed the good discrimination power of both scores (C‐statistic 0.80 for TRITAVIpre and 0.81 for TRITAVIpost score). Need for dialysis was associated with a significant increase in 1‐year mortality (from 6.9% to 54.4%; P=0.0001).
Conclusions A simple preprocedural clinical score can help predict the risk of dialysis after transcatheter aortic valve replacement.

Keywords: acute kidney injury; dialysis; mortality; risk score; transcatheter aortic valve replacement.

Nonstandard Abbreviations and Acronyms

  • RRT
  • renal replacement therapy
  • TAVR
  • transcatheter aortic valve replacement

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Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement

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Abstract

Background Dialysis is a rare but serious complication after transcatheter aortic valve replacement. We analyzed the large multicenter TRITAVI (transfusion requirements in transcatheter aortic valve implantation) registry in order to develop and validate a clinical score assessing this risk.
Methods and Results A total of 10 071 consecutive patients were enrolled in 19 European centers. Patients were randomly assigned (2:1) to a derivation and validation cohort. Two scores were developed, 1 including only preprocedural variables (TRITAVIpre) and 1 also including procedural variables (TRITAVIpost). In the 6714 patients of the derivation cohort (age 82±6 years, 48% men), preprocedural factors independently associated with dialysis and included in the TRITAVIpre score were male sex, diabetes, prior coronary artery bypass graft, anemia, nonfemoral access, and creatinine clearance <30 mL/min per m2. Additional independent predictors among procedural features were volume of contrast, need for transfusion, and major vascular complications. Both scores showed a good discrimination power for identifying risk for dialysis with C‐statistic 0.78 for TRITAVIpre and C‐statistic 0.88 for TRITAVIpost score. Need for dialysis increased from the lowest to the highest of 3 risk score groups (from 0.3% to 3.9% for TRITAVIpre score and from 0.1% to 6.2% for TRITAVIpost score). Analysis of the 3357 patients of the validation cohort (age 82±7 years, 48% men) confirmed the good discrimination power of both scores (C‐statistic 0.80 for TRITAVIpre and 0.81 for TRITAVIpost score). Need for dialysis was associated with a significant increase in 1‐year mortality (from 6.9% to 54.4%; P=0.0001).
Conclusions A simple preprocedural clinical score can help predict the risk of dialysis after transcatheter aortic valve replacement.

Keywords: acute kidney injury; dialysis; mortality; risk score; transcatheter aortic valve replacement.

Nonstandard Abbreviations and Acronyms

  • RRT
  • renal replacement therapy
  • TAVR
  • transcatheter aortic valve replacement

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