Impact of post-procedural hyperglycemia on acute kidney injury after transcatheter aortic valve implantation. (15th October 2016)

• Record Type: Journal Article
• Authors: Giannini, Francesco; Latib, Azeem; Jabbour, Richard J.; Ruparelia, Neil; Aurelio, Andrea; Ancona, Marco B.; Figini, Filippo; Mangieri, Antonio; Regazzoli, Damiano; Tanaka, Akihito; Montalto, Claudio; Azzalini, Lorenzo; Monaco, Fabrizio; Agricola, Eustachio; Chieffo, Alaide; Montorfano, Matteo; Alfieri, Ottavio; Colombo, Antonio
• Is Part Of: International journal of cardiology. Volume 221(2016)
• Page Start: 892
• Page End: 897
• Publication Date: 2016-10-15
• Subjects: Hyperglycemia -- Post-procedural -- Transcatheter aortic valve implantation -- Acute kidney injury; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.07.029
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Post-operative hyperglycemia, in individuals with and without diabetes, has been identified as a predictor of acute kidney injury (AKI) in patients following cardiac surgery. Whether or not this is also true for patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. Objectives: To evaluate whether post-procedural glucose levels are associated with AKI after TAVI. Methods and results: A total of 422 consecutive patients undergoing transfemoral TAVI were included in the analysis. For each patient, plasma glucose levels were assessed at hospital admission, 4 h after the procedure and daily during hospitalization. Post-procedural hyperglycemia was defined as 2 consecutive blood glucose readings ≥ 150 mg/dL in the 72-hour period following TAVI. AKI was defined according to the VARC consensus report regarding standardized endpoint definitions. Overall, 137 (32.5%) patients developed post-procedural hyperglycemia and 138 (33%) patients developed AKI. Hyperglycemia was associated with a 2-fold higher incidence of AKI than in patients without hyperglycemia (48% vs. 25%, p < 0.001). In-hospital mortality was higher in patients with hyperglycemia than in those without hyperglycemia (9.6% vs. 1.8%, p < 0.001). In-hospital mortality rate was also higher in patients who developed AKI (12.7% vs. 2.7%, p < 0.001). Patients with acute hyperglycemia that developed AKI had the highest in-hospital and long-term mortality rate (15% and 38%). Post-procedural hyperglycemia was an independent predictor of AKI. Conclusions: Post-procedural hyperglycemia is associated with a higher incidence of AKI and mortality after TAVI. Randomized controlled trials are needed to determine whether meticulous post-procedural glycemic control following TAVI impacts upon clinical outcomes.