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Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement.

Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement.

Authors :
Pasceri V
Pelliccia F
Mehran R
Dangas G
Porto I
Radico F
Biancari F
D'Ascenzo F
Saia F
Luzi G
Bedogni F
Amat Santos IJ
De Marzo V
Dimagli A
Mäkikallio T
Stabile E
Blasco-Turrión S
Testa L
Barbanti M
Tamburino C
Fabiocchi F
Chilmeran A
Conrotto F
Costa G
Stefanini G
Spaccarotella C
Macchione A
La Torre M
Bendandi F
Juvonen T
Wańha W
Wojakowski W
Benedetto U
Indolfi C
Hildick-Smith D
Zimarino M
Source :
Journal of the American Heart Association [J Am Heart Assoc] 2024 Apr 02; Vol. 13 (7), pp. e032955. Date of Electronic Publication: 2024 Mar 27.
Publication Year :
2024

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.<br />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 m <superscript>2</superscript> . 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).<br />Conclusions: A simple preprocedural clinical score can help predict the risk of dialysis after transcatheter aortic valve replacement.

Details

Language :
English
ISSN :
2047-9980
Volume :
13
Issue :
7
Database :
MEDLINE
Journal :
Journal of the American Heart Association
Publication Type :
Academic Journal
Accession number :
38533944
Full Text :
https://doi.org/10.1161/JAHA.123.032955