Author + information
- Zainab Samad,
- Joseph Sivak,
- Matthew Phelan,
- Phillip Schulte and
- Eric Velazquez
Background: The utilization of aortic valve replacement (AVR) in patients with CKD is not known. We tested the hypothesis that surgical intervention for AS is underutilized in patients with CKD.
Methods: Patients undergoing echocardiography between 1999-2013 with serum creatinine values within 6 months of the index echocardiographic study and no prior valve surgery were included. CKD was defined as estimated glomerular filtration rate <60ml/min/1.73m2 or an ICD-9 diagnosis of CKD or hemodialysis. Indication for AVR was defined by severe AS with either of the following: 1) CHF, 2) left ventricular ejection fraction ≤ 50%, or 3) 3-vessel/left main disease on coronary angiography (within 1 month before or 10 days after echo). Incidence of AVR within 1 year of echo with indication for AVR was described using cumulative incidence plots considering mortality as a competing risk. A Fine and Gray proportional hazards model was used to examine the association of CKD with incidence of AVR after adjusting for co-morbidities.
Results: A total 876 of 78059 patients had severe AS of which 749 (86%) met criteria for AVR. CKD was present in 57%(425/749) patients meeting criteria for AVR. AVR was undertaken in 47% (201/425) with CKD compared with 71% (231/324) without CKD. Patients who underwent AVR were older, had lower euroSCOREs, and higher LVEF compared with those who did not undergo AVR (all p <0.05). However, among patients who underwent AVR, those with CKD had significantly higher euroSCORES compared with those without CKD (median euroSCOREs: 9.9 vs 4.4; p <0.001). Presence of CKD was associated with lower incidence of AVR (Hazard ratio [HR] 0.72, 95% confidence interval 0.59, 0.88; p 0.0017) and this association remained significant after adjustment for co-morbidities (HR 0.67; 95% CI 0.55, 0.82; p=0.0001).
Conclusions: Presence of CKD was independently associated with reduced utilization of AVR in patients meeting criteria for AVR. Because the survival benefits of AVR extend to patients with CKD, further research is required to evaluate this disparity in care and investigate new methods to treat severe AS in this patient population.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 4:00 p.m.-4:10 p.m.
Session Title: Valvular Heart Disease With CKD or Cirrhosis
Abstract Category: 37. Valvular Heart Disease: Therapy
Presentation Number: 1172M-05
- 2017 American College of Cardiology Foundation