Impact of bleeding after transcatheter aortic valve replacement in patients with chronic kidney disease
- 22 May 2020
- journal article
- research article
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 97 (1), E172-E178
- https://doi.org/10.1002/ccd.28989
Abstract
Objective In patients with chronic kidney disease (CKD) undergoing transcatheter aortic valve replacement (TAVR), this study aims to elucidate (a) the bleeding risks associated with CKD, (b) the association between bleeding and subsequent mortality, and (c) the pattern of antithrombotic therapy prescribed. Background Patients with CKD have a higher risk of bleeding following TAVR. It is unclear whether this risk persists beyond the periprocedural period and whether it negatively impacts mortality. Methods A retrospective review was performed on patients who underwent TAVR at Massachusetts General Hospital from 2008 to 2017. CKD was defined as estimated glomerular filtration rate less than 60 ml/min/1.73 m2. Primary endpoints up to 1‐year following TAVR included bleeding, all‐cause mortality, and ischemic stroke. Outcomes for patients with and without CKD were compared using log‐rank test, and Cox regression with age, sex, and diabetes as covariates. Bleeding was treated as a time‐varying covariate, and Cox proportional hazard regression was utilized to model mortality. Results Of the 773 patients analyzed, 466 (60.3%) had CKD. At 1 year, CKD patients had higher rates of bleeding (9.2 vs. 4.9%, adjusted hazard ratios [aHR] = 1.91, p = .032) and all‐cause mortality (13.7 vs. 9.1%, aHR = 1.57, p = .049), but not stroke (3.9 vs. 1.6% aHR = 0.073, p = .094). Bleeding was associated with an increased risk of subsequent mortality (aHR = 2.65, 95% CI: 1.25–5.63, p = .01). There were no differences in the antithrombotic strategy following TAVR between CKD and non‐CKD patients. Conclusion CKD is associated with a higher risk of bleeding up to 1 year following TAVR. Long‐term bleeding after TAVR is associated with increased subsequent mortality.Keywords
This publication has 24 references indexed in Scilit:
- Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk PatientsThe New England Journal of Medicine, 2019
- Chronic kidney disease is associated with increased mortality and procedural complications in transcatheter aortic valve replacement: a systematic review and meta‐analysisCatheterization and Cardiovascular Interventions, 2019
- Antithrombotic Therapy After Transcatheter Aortic Valve ReplacementCirculation: Cardiovascular Interventions, 2019
- Association of Chronic Kidney Disease With In-Hospital Outcomes of Transcatheter Aortic Valve ReplacementJACC: Cardiovascular Interventions, 2017
- Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk PatientsThe New England Journal of Medicine, 2016
- Advanced chronic kidney disease in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes and prognostic markers from a large cohort of patientsEuropean Heart Journal, 2014
- Haemostasis in chronic kidney diseaseNephrology Dialysis Transplantation, 2013
- Impact of Bleeding on Mortality After Percutaneous Coronary Intervention: Results From a Patient-Level Pooled Analysis of the REPLACE-2 (Randomized Evaluation of PCI Linking Angiomax to Reduced Clinical Events), ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy), and HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) TrialsJACC: Cardiovascular Interventions, 2011
- Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo SurgeryThe New England Journal of Medicine, 2010
- Associations of major bleeding and myocardial infarction with the incidence and timing of mortality in patients presenting with non-ST-elevation acute coronary syndromes: a risk model from the ACUITY trialEuropean Heart Journal, 2009