Contrast-Induced Acute Kidney Injury in Patients Undergoing TAVI Compared With Coronary Interventions

Background Differences in the impact of contrast medium on the development of contrast-induced acute kidney injury (CI-AKI) in patients undergoing transcatheter aortic valve implantation (TAVI) or a coronary angiography/percutaneous coronary intervention (CA/PCI) have not been previously investigated. Methods and Results Patients treated with TAVI or elective CA/PCI were retrospectively analyzed in terms of baseline and procedural characteristics, including preprocedural and postprocedural kidney function. CI-AKI was defined as a relative increase in serum creatinine concentration of at least 0.3 mg/dL within 72 hours of contrast-medium administration compared with baseline. The incidence of CI-AKI in the TAVI versus CA/PCI group was compared. After the exclusion of patients in dialysis and emergency procedures, 977 patients were analyzed; there were 489 patients who had undergone TAVI (50.1%) and 488 patients who had undergone CA/PCI (49.9%). Patients treated by TAVI were older, presenting a higher rate of anemia and chronic kidney disease (P<0.001 for all comparisons). Consistently, they also had a significantly lower glomerular filtration rate and higher serum creatinine concentration (P<0.001 for all). However, the occurrence of CI-AKI was significantly lower in these patients compared with patients treated by a CA/PCI (6.7% versus 14.5%, P<0.001). At multivariate analysis, the TAVI procedure had an independent protective effect on CI-AKI incidence among total population (odds ratio, 0.334; 95% CI, 0.193-0.579; P<0.001). This observation was confirmed after propensity score matching among 360 patients (180 by TAVI and 180 by CA/PCI; P=0.002). Conclusions CI-AKI occurred less frequently in patients undergoing TAVI than in patients undergoing a CA/PCI, despite a worse-risk profile. The impact of contrast administration on kidney function in patients who had undergone TAVI may be better tolerated because of the hemodynamic changes following aortic valve replacement.