title: Impact of post-procedural hyperglycemia on acute kidney injury after transcatheter aortic valve implantation.
abstract: BACKGROUND
  Post-operative hyperglycemia, in individuals with and without diabetes, has been identified as a predictor of acute kidney injury (AKI) in patients following cardiac surgery. Whether or not this is also true for patients undergoing transcatheter aortic valve implantation (TAVI) is unknown.
  
  
  OBJECTIVE
  To evaluate whether post-procedural glucose levels are associated with AKI after TAVI.
  
  
  RESULTS
  A total of 422 consecutive patients undergoing transfemoral TAVI were included in the analysis. For each patient, plasma glucose levels were assessed at hospital admission, 4h after the procedure and daily during hospitalization. Post-procedural hyperglycemia was defined as 2 consecutive blood glucose readings ≥150mg/dL in the 72-hour period following TAVI. AKI was defined according to the VARC consensus report regarding standardized endpoint definitions. Overall, 137 (32.5%) patients developed post-procedural hyperglycemia and 138 (33%) patients developed AKI. Hyperglycemia was associated with a 2-fold higher incidence of AKI than in patients without hyperglycemia (48% vs. 25%, p<0.001). In-hospital mortality was higher in patients with hyperglycemia than in those without hyperglycemia (9.6% vs. 1.8%, p<0.001). In-hospital mortality rate was also higher in patients who developed AKI (12.7% vs. 2.7%, p<0.001). Patients with acute hyperglycemia that developed AKI had the highest in-hospital and long-term mortality rate (15% and 38%). Post-procedural hyperglycemia was an independent predictor of AKI.
  
  
  CONCLUSIONS
  Post-procedural hyperglycemia is associated with a higher incidence of AKI and mortality after TAVI. Randomized controlled trials are needed to determine whether meticulous post-procedural glycemic control following TAVI impacts upon clinical outcomes.
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy. Electronic address: giannini_fra@yahoo.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giannini
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy; Imperial College London, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Jabbour
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Neil
authors.initials: N
authors.lastname: Ruparelia
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Aurelio
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy.
authors.forename: Marco B
authors.initials: MB
authors.lastname: Ancona
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Figini
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Mangieri
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Regazzoli
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Akihito
authors.initials: A
authors.lastname: Tanaka
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Montalto
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Azzalini
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Monaco
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy.
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.affiliation: Cardiac Surgery Unit, San Raffaele Hospital, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000639:trends; D016896:Treatment Outcome
keywords: Acute kidney injury; Hyperglycemia; Post-procedural; Transcatheter aortic valve implantation