Abstract 11644: Impact of Renal Insufficiency on Outcome After MitraClip-Procedure: Results from the German TRAMI Registry
Background: Transcatheter repair of mitral valve regurgitation (TRAMI) with the MitraClip procedure is an evolving technique. Renal insufficiency is known as an independent predictor for death in different patient populations. Aims of this substudy of the multi-center German TRAMI registry was to determine the predictive value of renal insufficiency for procedure related complications after TRAMI.
Methods and Results: 440 patients were included in this analysis. The cohort was separated according to renal function (A: GFR <= 30ml/, n=56, 12.7%; B: GFR >30 <60ml/min, n= 228, 52.8%; C: GFR >=60ml/min, n=156, 35.5%). Mean creatinine in group A was 2.7mg/dl; group B, 1.4mg/dl; group C, 0.9mg/dl; p<0.0001. 80.0% of the patients in group A had a creatinine of 2mg/dl or higher (group B, 8.3%; group C, 0.0%; p<0.0001). The groups did not differ significantly concerning baseline characteristics. Patients with severe renal insufficiency were more likely to have a history of myocardial infarction (41.1% vs. 31.0% vs. 22.4%, p<0.05), had more often been hospitalized in intensive care units (16.1%vs. 4.9% vs. 4.5%, p<0.05). Despite the logistic EuroScore and STS-Score did not differ significantly between groups (16.0 vs. 17.5 vs. 14.0 respectively 11.0 vs. 11.5 vs. 9.0), patients in group A had a higher rate of in-hospital death after the procedure (7.1% vs. 1.8% vs. 1.3%, p<0.05), needed more blood transfusions (22.6% vs. 10.6% vs. 4.6%, p<0.05), had more ischemic cerebrovascular events (5.6% vs. 0.9% vs. 1.3%, p=0.05), and were longer hospitalized after TRAMI (11.5 days vs. 9.0 days vs. 8.0 days, p<0.05). After 30 days of follow-up patients from group A presented significantly more often with NYHA class II-IV (70.6% vs. 39.7% vs. 29.7%, p<0.01) There was a trend towards an increased overall mortality of patients in group A (19.2% vs. 15.6% vs. 5.6%, p=0.07).
Conclusions: In this real-world TRAMI registry, patients with preexisting renal insufficiency (GFR <= 30ml/min) had a higher rate of procedural complications and worse functional status during 30 day follow up. Interestingly, the established risk scores failed to predict adverse outcome.
- © 2011 by American Heart Association, Inc.