Abstract 8958: Cystatin C is Superior to Creatinine in Risk Prediction After Transcatheter Aortic Valve Replacement

Abstract

Introduction: Cystatin C is an alternative marker of renal function less influenced by age, sex, race, and muscle mass compared with creatinine. No data has been reported about the prognostic meaning of chronic kidney disease classification by cystatin C-based estimated glomerular filtration rate (CKD Cys classification) in patients undergoing transcatheter aortic valve replacement (TAVR). Objective: The aim of this study was to compare the prognostic value of CKD Cys classification and classification by creatinine-based estimated glomerular filtration rate (CKD Cr classification) in the risk prediction after TAVR. Methods: We retrospectively analyzed consecutive 219 patients with symptomatic severe aortic stenosis who underwent TAVR in our institute between December 2016 and June 2019. Preoperative CKD Cys classification and CKD Cr classification were evaluated for their prognostic value of 2-year major adverse cardiovascular and cerebrovascular event (MACCE) after TAVR. MACCE was defined as the composite of all-cause mortality, myocardial infarction, cerebrovascular events, and rehospitalization for worsening congestive heart failure. Results: There were 59 MACCEs during the median follow-up period of 575.5days. CKD Cys classification not CKD Cr classification significantly stratified the risk of 2-year MACCE in patients after TAVR by log-rank test (P=0.002) (Figure 1). In multivariate Cox regression analysis, only CKD Cys classification stage 3b (hazard ratio=4.37; 95% confidence interval: 1.28 to 14.91; P=0.019) and CKD Cys classification stage4+5 (hazard ratio=3.72; 95% confidence interval: 1.06 to 12.99; P=0.040) were the independent predictors for MACCE after adjustment for potential confounders. Conclusions: The use of CKD Cys classification could provide better risk assessment than CKD Cr classification in patients undergoing TAVR. CKD Cys classification stage3b and stage4+5 correlated with adverse outcomes.