Abstract 10126: Impact of Albuminuria on Prognosis After Transcatheter Aortic Valve Replacement for Aortic Stenosis

Abstract

Introduction: Albuminuria is a well-known risk factor of cardiovascular events. However, the impact of albuminuria on the prognosis in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) has not been studied. Methods: This is a single-center retrospective observational study. Consecutive patients who underwent TAVI for severe AS and whose preoperative urinary data were available were included. Finally, 228 patients were investigated. Patients were divided into two groups according to the preoperative urinary albumin-to-creatinine ratio (ACR): high (ACR≥ 30 mg/g) and low (ACR<30 mg/g). Total protein to creatinine ratio (PCR) and dipstick proteinuria were also evaluated. The primary outcome was a composite endpoint of all-cause death and readmission due to heart failure. Results: There were 117 patients with a high ACR and 111 patients with a low ACR. At baseline, patients with a high ACR had significantly lower eGFR than those with a low ACR. During the median follow-up period of 467 days, the patients with a high ACR had higher incidence of a primary endpoint than those with a low ACR (p<0.001). The individual incidence of all-cause death, cardiac death and heart failure readmission were also significantly higher in patients with a high ACR than those with a low ACR. Patients with PCR≥150mg/g or positive dipstick proteinuria were at a higher risk of primary endpoint as well (p<0.001 and p=0.008, respectively), however, there was no significant difference between the patients with eGFR<60 and ≥60 mL/min/1.73m 2 (Figure). Multivariate Cox proportional hazards analysis showed a high ACR was independently associated with a primary endpoint (HR, 4.98; 95% CI, 1.84-13.49; p=0.002). Conclusions: Preoperative albuminuria (ACR≥ 30 mg/g) is an independent predictor of cardiac events in the patients with severe AS undergoing TAVI. PCR≥150 mg/g and positive dipstick albuminuria are also useful for risk prediction.