Acute Kidney Injury After Percutaneous Edge-to-Edge Mitral Repair.

Autor:	Armijo G; Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain. Electronic address: https://twitter.com/german_armijo., Estevez-Loureiro R; Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Vigo, Spain. Electronic address: https://twitter.com/RodrigoEstvez1., Carrasco-Chinchilla F; Hospital Clínico Universitario Virgen de la Victoria, Málaga, CIBERCV, Málaga, Spain., Arzamendi D; Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain., Fernández-Vázquez F; Department of Cardiology, University Hospital of León, León, Spain., Jimenez-Quevedo P; Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Freixa X; Cardiology Department Cardiovascular Institute, Hospital Clínic, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain., Pascual I; Heart Area, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, Asturias, Spain., Serrador AM; Cardiology Department, Hospital Clínico Universitario de Valladolid, CIVERCV, Valladolid, Spain., Mesa D; Cardiology Department, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain., Alonso-Briales JH; Hospital Clínico Universitario Virgen de la Victoria, Málaga, CIBERCV, Málaga, Spain., Goicolea J; Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain., Hernández-Antolin R; Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain., Fernández-Peregrina E; Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain., Cid Alvarez AB; Hospital Clínico Universitario de Santiago, CIBERCV, Santiago, Spain., Andraka L; Cardiology Department, Hospital de Basurto, Bilbao, Spain., Cruz-Gonzalez I; Cardiology Department, Hospital Clínico Universitario de Salamanca-Instituto de Investigación Biomédica de Salamanca, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Salamanca, Spain., Berenguer A; Cardiology Department, Hospital General Universitario de Valencia, Valencia, Spain., Sanchis J; Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, CIBERCV, Spain., Diez Gil JL; Cardiology Department, Hospital Universitario y Politécnico, La Fe, Valencia, Spain., Hernández-García JM; Hospital Clínico Universitario Virgen de la Victoria, Málaga, CIBERCV, Málaga, Spain., Li CH; Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain., Benito-González T; Department of Cardiology, University Hospital of León, León, Spain., de Agustin JA; Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Avanzas P; Heart Area, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, Asturias, Spain., Regueiro A; Cardiology Department Cardiovascular Institute, Hospital Clínic, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain., Amat-Santos I; Cardiology Department, Hospital Clínico Universitario de Valladolid, CIVERCV, Valladolid, Spain. Electronic address: https://twitter.com/ignamatsant., Pan M; Cardiology Department, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain., Nombela-Franco L; Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain. Electronic address: luisnombela@yahoo.com.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2020 Nov 24; Vol. 76 (21), pp. 2463-2473.
DOI:	10.1016/j.jacc.2020.09.582
Abstrakt:	Background: In catheter-based procedures, acute kidney injury (AKI) is a frequent, serious complication ranging from 10% to 30%. In MitraClip (Abbott Vascular, Santa Clara, California), a usually contrast-free procedure, there is scarce data about its real incidence and impact. Objectives: This study aimed to evaluate incidence, predictive factors, and midterm outcomes of AKI in patients with significant mitral regurgitation (MR) undergoing transcatheter valve repair with MitraClip. Methods: A total of 721 patients undergoing MitraClip were included. AKI was defined as an absolute or a relative increase in serum creatinine of >0.3 mg/dl or ≥50%, respectively, or the need for hemodialysis during index hospitalization. Results: The mean age of the patients was 72 ± 11 years (28.3% women). Median estimated glomerular filtration rate (eGFR) was 43.7 ml/min/1.73 m 2 (interquartile range: 30.9 to 60.1 ml/min/1.73 m 2 ), and was <60 ml/min/1.73 m 2 in 74.9% of the patients. AKI after MitraClip occurred in 106 patients (14.7%). Baseline hemoglobin (<11 g/dl) (odds ratio [OR]: 1.97; p = 0.003), urgent procedure (OR: 3.44; p = 0.003), and absence of device success (OR: 3.37; p < 0.001) were independent predictors of AKI. Patients with AKI had worse outcomes compared to those without AKI, including a higher proportion of in-hospital bleeding events (3.8% vs. 0.8%; p = 0.011), 2-year all-cause mortality (40.5% vs. 18.7%; p <0.001), and major adverse cardiac events (63.6% vs. 23.5%; p <0.001). Combination of AKI with significant residual MR after the procedure conferred even worst outcomes (2-year all-cause mortality 50.0% vs. 19.6%; p = 0.001, and major adverse cardiac events 70.0% vs. 18.9%; p < 0.001). Conclusions: Despite being a "zero-contrast" procedure, one-sixth of patients undergoing transcatheter mitral valve repair had AKI, linked to device failure or other severe conditions. The occurrence of AKI was associated with worse outcomes, highlighting the importance to detect and reduce this complication in high-risk population. Competing Interests: Author Relationship With Industry The electronic database for the Spanish MitraClip registry is maintained by an unrestricted grant from Abbott. This study was supported by Fundación Interhospitalaria para la Investigación Cardiovascular (FIC Foundation) via an unrestricted grant from Abbott. Drs. Estevez-Loureiro, Arzamendi, Freixa, Cruz-Gonzalez, de Agustin, and Nombela-Franco have served as proctors for Abbott. Dr. Pan has received lecture fees from Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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