Incidence, Predictors, and Prognostic Value of Acute Kidney Injury Among Patients Undergoing Left Atrial Appendage Closure.

Autor:	Nombela-Franco L; Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain. Electronic address: luisnombela@yahoo.com., Rodés-Cabau J; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada., Cruz-Gonzalez I; Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca, CIBER-CV, Salamanca, Spain., Freixa X; Department of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain., Asmarats L; Hospital Universitari Son Espases, Palma, Balearic Islands, Spain., Gutiérrez H; Institute of Heart Sciences, Hospital Clínico Universitario of Valladolid, Valladolid, Spain., Sahay S; Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Rodriguez-Gabella T; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada., Moreno-Samos JC; Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca, CIBER-CV, Salamanca, Spain., Tirado-Conte G; Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Goncalves-Ramirez LR; Institute of Heart Sciences, Hospital Clínico Universitario of Valladolid, Valladolid, Spain., Rama-Merchan JC; Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca, CIBER-CV, Salamanca, Spain., Amat-Santos IJ; Institute of Heart Sciences, Hospital Clínico Universitario of Valladolid, Valladolid, Spain., O'Hara G; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada., Martín-Yuste V; Department of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain., Bethencourt A; Hospital Universitari Son Espases, Palma, Balearic Islands, Spain., Jimenez-Quevedo P; Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Macaya C; Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2018 Jun 11; Vol. 11 (11), pp. 1074-1083.
DOI:	10.1016/j.jcin.2018.03.022
Abstrakt:	Objectives: The aims of this registry were to determine the incidence, predictors, and prognostic value of periprocedural acute kidney injury (AKI) after left atrial appendage closure (LAAC). Background: No data exist on the occurrence of AKI after LAAC. Methods: A total of 355 patients undergoing LAAC were included in the study. AKI was defined as an absolute or a relative increase in serum creatinine of >0.3 mg/dl or ≥50%, respectively, after the procedure or the need for hemodialysis during index hospitalization. Results: The incidence of AKI was 9%, and patients with worse baseline renal function were at higher risk for developing AKI (odds ratio: 1.32; 95% confidence interval [CI]: 1.09 to 1.61; p = 0.004 for each 10 ml/min decrease in glomerular filtration rate). In-hospital bleeding events occurred more frequently in the AKI group (5.3% vs. 15.6%; p = 0.037). After a median follow-up period of 18 months, patients in the AKI group had higher mortality (hazard ratio [HR]: 2.59; 95% CI: 1.36 to 4.92; p = 0.004), more embolic events (HR: 6.14; 95% CI: 2.23 to 16.92; p = 0.001) and major bleeding events (HR: 2.36; 95% CI: 0.89 to 6.24; p = 0.083). The occurrence of AKI was an independent predictor of midterm mortality (HR: 2.00; 95% CI: 1.02 to 3.91; p = 0.044). Conclusions: The occurrence of AKI was relatively frequent following LAAC, and patients with lower renal glomerular filtration rates were at high risk for developing this complication. AKI identified a group of patients with worse midterm outcomes, highlighting the importance of further preventive strategies in this population. (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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