TAVR低对比策略：预防慢性肾脏疾病肾损伤的可行性和结果

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2025-03-17 DOI:10.1002/ccd.31490

Brigitte Kazzi, David I. Blusztein, Chunhui Wang, Yuming Ning, Tamim Nazif, Rebecca T. Hahn, Martin Leon, Paul A. Kurlansky, Susheel Kodali, Isaac George

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引用次数: 0

摘要

背景：造影剂体积是慢性肾脏疾病（CKD）患者TAVR术后急性肾损伤（AKI）的主要危险因素。在TAVR中使用低对比度（LC）方案可以减少AKI，而不影响其他临床结果。方法：2015 - 2020年间伴有3b期或更严重CKD的TAVR患者分为LC和正常对比（NC）两组。LC定义为TAVR手术造影剂使用（mL）低于估计的肾小球滤过率（eGFR, mL/min/1.73 m2）。主要终点为AKI，定义为肌酐水平较基线升高bb0 200%或≥0.3 mg/dL。次要结局是30天死亡率、住院时间、30天瓣旁渗漏、新的透析需求、主要血管并发症、再入院、出血和次要结局的复合主要终点。我们进行了倾向匹配分析，比较了队列结果和AKI严重程度的分层结果。结果：共分析437例患者。LC组（n = 173）多为男性，基线eGFR（31比33，p = 0.03）低于NC组（n = 264）。倾向匹配后，LC患者AKI发生率低于NC患者（17.9% vs. 28.3%, p = 0.0217）。在死亡率、新的透析需求、主要血管并发症、出血或再入院方面，组间无差异。结论：在TAVR合并CKD患者中，LC容量与AKI风险降低相关，支持CKD患者TAVR的LC方法。目的：我们试图评估CKD患者TAVR中LC与正常对比剂量策略的结果。

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Low Contrast Strategies in TAVR: Feasibility and Outcomes to Prevent Renal Injury in Chronic Kidney Disease

Background

Contrast volume is a major risk factor for acute kidney injury (AKI) in patients with chronic kidney disease (CKD) after TAVR. Use of a low-contrast (LC) protocol in TAVR may reduce AKI without impacting other clinical outcomes.

Methods

TAVR patients with Stage 3b or worse CKD between 2015 and 2020 were grouped into LC and normal-contrast (NC). LC was defined as TAVR procedure contrast use (mL) less than estimated glomerular filtration rate (eGFR, mL/min/1.73 m²). The primary outcome was AKI, defined as creatinine elevation > 200% or ≥ 0.3 mg/dL from baseline. Secondary outcomes were 30-day mortality, length of stay, paravalvular leak at 30 days, new dialysis requirement, major vascular complication, re-admission, bleeding, and a composite primary endpoint of secondary outcomes. We performed a propensity-matched analysis, compared cohort outcomes, and stratified outcomes by AKI severity.

Results

Four hundred thirty-seven patients were analyzed. The LC group (n = 173) were more commonly male and had a lower baseline eGFR (31 vs. 33, p = 0.03) than the NC group (n = 264). After propensity-matching, AKI occurred less frequently in LC patients than in the NC patients (17.9 vs. 28.3%, p = 0.0217). There were no inter-group differences in mortality, new dialysis requirement, major vascular complications, bleeding, or re-admissions.

Conclusions

In TAVR patients with CKD, LC volume was associated with reduced risk of AKI, supporting a LC approach for TAVR in CKD patients.

Aims

We sought to evaluate the outcomes of a LC versus normal-contrast dose strategy in TAVR amongst patients with CKD.

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.