Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Andres M. Pineda, J. Kevin Harrison, Neal S. Kleiman, Michael J. Reardon, John V. Conte, Daniel P. O'Hair, Stanley J. Chetcuti, Jian Huang, Steven J. Yakubov, Jeffrey J. Popma, Nirat Beohar

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: To assess the treatment effect of TAVR versus SAVR on clinical outcomes to 3 years in patients stratified by chronic kidney disease (CKD) by retrospectively studying patients randomized to TAVR or SAVR. Background: The impact of CKD on mid-term outcomes of patients undergoing TAVR versus SAVR is unclear. Methods: Patients randomized to TAVR or SAVR in the CoreValve US Pivotal High Risk Trial were retrospectively stratified by eGFR: none/mild or moderate/severe CKD. To evaluate the impact of baseline CKD in TAVR patients only, all patients undergoing an attempted TAVR implant in the US Pivotal Trial and CAS were stratified by baseline eGFR into none/mild, moderate, and severe CKD. The primary endpoint was major adverse cardiovascular and renal events (MACRE), a composite of all-cause mortality, myocardial infarction, stroke/TIA, and new requirement of dialysis. Results: Moderate/severe CKD was present in 62.7% and 60.7% of high-risk patients randomized to TAVR or SAVR, respectively. Baseline characteristics were similar between TAVR and SAVR patients in both CKD subgroups, except for higher rates of diabetes and higher serum creatinine in SAVR patients. Among high-risk patients with moderate/severe CKD, TAVR provided a lower 3-year MACRE rate compared with SAVR: 42.1% vs. 51.0, P =.04. Of 3,733 extreme- and high-risk TAVR patients, 39.9% had none/mild, 53.8% moderate, and 6.4% severe CKD. Worsening baseline CKD was associated with increased 3-year MACRE rates [none/mild 51.5%, moderate 54.5%, severe 63.1%, P =.001]. Conclusions: TAVR results in lower 3-year MACRE versus SAVR in high-risk patients with moderate/severe CKD. In patients undergoing TAVR, worsening CKD increases mid-term mortality and MACRE. Randomized trials of TAVR vs. SAVR in patients with moderate-severe CKD would help elucidate the best treatment for these complex patients. Trial Registration: CoreValve US Pivotal Trial: NCT01240902. CoreValve Continued Access Study: NCT01531374.

Original languageEnglish (US)
Pages (from-to)740-748
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume93
Issue number4
DOIs
StatePublished - Mar 1 2019

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Aortic Valve
Chronic Renal Insufficiency
Surgical Instruments
Kidney
Mortality
Dialysis
Creatinine
Stroke

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Pineda, Andres M. ; Kevin Harrison, J. ; Kleiman, Neal S. ; Reardon, Michael J. ; Conte, John V. ; O'Hair, Daniel P. ; Chetcuti, Stanley J. ; Huang, Jian ; Yakubov, Steven J. ; Popma, Jeffrey J. ; Beohar, Nirat. / Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement. In: Catheterization and Cardiovascular Interventions. 2019 ; Vol. 93, No. 4. pp. 740-748.
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title = "Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement",
abstract = "Objectives: To assess the treatment effect of TAVR versus SAVR on clinical outcomes to 3 years in patients stratified by chronic kidney disease (CKD) by retrospectively studying patients randomized to TAVR or SAVR. Background: The impact of CKD on mid-term outcomes of patients undergoing TAVR versus SAVR is unclear. Methods: Patients randomized to TAVR or SAVR in the CoreValve US Pivotal High Risk Trial were retrospectively stratified by eGFR: none/mild or moderate/severe CKD. To evaluate the impact of baseline CKD in TAVR patients only, all patients undergoing an attempted TAVR implant in the US Pivotal Trial and CAS were stratified by baseline eGFR into none/mild, moderate, and severe CKD. The primary endpoint was major adverse cardiovascular and renal events (MACRE), a composite of all-cause mortality, myocardial infarction, stroke/TIA, and new requirement of dialysis. Results: Moderate/severe CKD was present in 62.7{\%} and 60.7{\%} of high-risk patients randomized to TAVR or SAVR, respectively. Baseline characteristics were similar between TAVR and SAVR patients in both CKD subgroups, except for higher rates of diabetes and higher serum creatinine in SAVR patients. Among high-risk patients with moderate/severe CKD, TAVR provided a lower 3-year MACRE rate compared with SAVR: 42.1{\%} vs. 51.0, P =.04. Of 3,733 extreme- and high-risk TAVR patients, 39.9{\%} had none/mild, 53.8{\%} moderate, and 6.4{\%} severe CKD. Worsening baseline CKD was associated with increased 3-year MACRE rates [none/mild 51.5{\%}, moderate 54.5{\%}, severe 63.1{\%}, P =.001]. Conclusions: TAVR results in lower 3-year MACRE versus SAVR in high-risk patients with moderate/severe CKD. In patients undergoing TAVR, worsening CKD increases mid-term mortality and MACRE. Randomized trials of TAVR vs. SAVR in patients with moderate-severe CKD would help elucidate the best treatment for these complex patients. Trial Registration: CoreValve US Pivotal Trial: NCT01240902. CoreValve Continued Access Study: NCT01531374.",
author = "Pineda, {Andres M.} and {Kevin Harrison}, J. and Kleiman, {Neal S.} and Reardon, {Michael J.} and Conte, {John V.} and O'Hair, {Daniel P.} and Chetcuti, {Stanley J.} and Jian Huang and Yakubov, {Steven J.} and Popma, {Jeffrey J.} and Nirat Beohar",
year = "2019",
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language = "English (US)",
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journal = "Catheterization and Cardiovascular Interventions",
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}

Pineda, AM, Kevin Harrison, J, Kleiman, NS, Reardon, MJ, Conte, JV, O'Hair, DP, Chetcuti, SJ, Huang, J, Yakubov, SJ, Popma, JJ & Beohar, N 2019, 'Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement', Catheterization and Cardiovascular Interventions, vol. 93, no. 4, pp. 740-748. https://doi.org/10.1002/ccd.27928

Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement. / Pineda, Andres M.; Kevin Harrison, J.; Kleiman, Neal S.; Reardon, Michael J.; Conte, John V.; O'Hair, Daniel P.; Chetcuti, Stanley J.; Huang, Jian; Yakubov, Steven J.; Popma, Jeffrey J.; Beohar, Nirat.

In: Catheterization and Cardiovascular Interventions, Vol. 93, No. 4, 01.03.2019, p. 740-748.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

AU - Pineda, Andres M.

AU - Kevin Harrison, J.

AU - Kleiman, Neal S.

AU - Reardon, Michael J.

AU - Conte, John V.

AU - O'Hair, Daniel P.

AU - Chetcuti, Stanley J.

AU - Huang, Jian

AU - Yakubov, Steven J.

AU - Popma, Jeffrey J.

AU - Beohar, Nirat

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Objectives: To assess the treatment effect of TAVR versus SAVR on clinical outcomes to 3 years in patients stratified by chronic kidney disease (CKD) by retrospectively studying patients randomized to TAVR or SAVR. Background: The impact of CKD on mid-term outcomes of patients undergoing TAVR versus SAVR is unclear. Methods: Patients randomized to TAVR or SAVR in the CoreValve US Pivotal High Risk Trial were retrospectively stratified by eGFR: none/mild or moderate/severe CKD. To evaluate the impact of baseline CKD in TAVR patients only, all patients undergoing an attempted TAVR implant in the US Pivotal Trial and CAS were stratified by baseline eGFR into none/mild, moderate, and severe CKD. The primary endpoint was major adverse cardiovascular and renal events (MACRE), a composite of all-cause mortality, myocardial infarction, stroke/TIA, and new requirement of dialysis. Results: Moderate/severe CKD was present in 62.7% and 60.7% of high-risk patients randomized to TAVR or SAVR, respectively. Baseline characteristics were similar between TAVR and SAVR patients in both CKD subgroups, except for higher rates of diabetes and higher serum creatinine in SAVR patients. Among high-risk patients with moderate/severe CKD, TAVR provided a lower 3-year MACRE rate compared with SAVR: 42.1% vs. 51.0, P =.04. Of 3,733 extreme- and high-risk TAVR patients, 39.9% had none/mild, 53.8% moderate, and 6.4% severe CKD. Worsening baseline CKD was associated with increased 3-year MACRE rates [none/mild 51.5%, moderate 54.5%, severe 63.1%, P =.001]. Conclusions: TAVR results in lower 3-year MACRE versus SAVR in high-risk patients with moderate/severe CKD. In patients undergoing TAVR, worsening CKD increases mid-term mortality and MACRE. Randomized trials of TAVR vs. SAVR in patients with moderate-severe CKD would help elucidate the best treatment for these complex patients. Trial Registration: CoreValve US Pivotal Trial: NCT01240902. CoreValve Continued Access Study: NCT01531374.

AB - Objectives: To assess the treatment effect of TAVR versus SAVR on clinical outcomes to 3 years in patients stratified by chronic kidney disease (CKD) by retrospectively studying patients randomized to TAVR or SAVR. Background: The impact of CKD on mid-term outcomes of patients undergoing TAVR versus SAVR is unclear. Methods: Patients randomized to TAVR or SAVR in the CoreValve US Pivotal High Risk Trial were retrospectively stratified by eGFR: none/mild or moderate/severe CKD. To evaluate the impact of baseline CKD in TAVR patients only, all patients undergoing an attempted TAVR implant in the US Pivotal Trial and CAS were stratified by baseline eGFR into none/mild, moderate, and severe CKD. The primary endpoint was major adverse cardiovascular and renal events (MACRE), a composite of all-cause mortality, myocardial infarction, stroke/TIA, and new requirement of dialysis. Results: Moderate/severe CKD was present in 62.7% and 60.7% of high-risk patients randomized to TAVR or SAVR, respectively. Baseline characteristics were similar between TAVR and SAVR patients in both CKD subgroups, except for higher rates of diabetes and higher serum creatinine in SAVR patients. Among high-risk patients with moderate/severe CKD, TAVR provided a lower 3-year MACRE rate compared with SAVR: 42.1% vs. 51.0, P =.04. Of 3,733 extreme- and high-risk TAVR patients, 39.9% had none/mild, 53.8% moderate, and 6.4% severe CKD. Worsening baseline CKD was associated with increased 3-year MACRE rates [none/mild 51.5%, moderate 54.5%, severe 63.1%, P =.001]. Conclusions: TAVR results in lower 3-year MACRE versus SAVR in high-risk patients with moderate/severe CKD. In patients undergoing TAVR, worsening CKD increases mid-term mortality and MACRE. Randomized trials of TAVR vs. SAVR in patients with moderate-severe CKD would help elucidate the best treatment for these complex patients. Trial Registration: CoreValve US Pivotal Trial: NCT01240902. CoreValve Continued Access Study: NCT01531374.

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