Acute kidney injury following preprocedural CT evaluation in TAVI candidates

Introduction: Contrast-associated acute kidney injury (CA-AKI) can develop within 9 days of contrast media administration, and is associated with adverse prognosis. Pre-existing cardiovascular conditions may increase CA-AKI risk. Aortic stenosis patients undergoing pre-Trans-catheter Aortic Valve Implantation (TAVI) CT may be at risk for CA-AKI.

Methods: A retrospective, single-center cohort study. The study sample included TAVI candidates who underwent pre-procedural CT at Shaare Zedek Medical Center from 2010 to 2024. Non-TAVI cardiac CT patients served as control. The primary outcome was AKI incidence within 9 days of the CT. AKI was defined as an increase in serum creatinine by ≥0.3 mg/dL, or an increase ≥1.5 times baseline. Statistical analysis was performed with RStudio 2024.12.0, using Chi-square test to compare AKI incidence, and T-test to compare demographic and clinical parameters.

Results and Discussion: 878 patients were included, 162 in the TAVI group and 716 in the non-TAVI control group. Average age was higher in the TAVI group (77.52±12.64) compared to the non-TAVI group (56.36 ±17.47, p<0.001). Baseline eGFR was lower 63.30±27.18 ml/min/1.73m² in the TAVI group and 90.06±25.31 ml/min/1.73m² (p<0.001) in the non-TAVI group, while contrast media volumes were lower- 59.63±22.58 ml versus 71.07±19.82 ml (p<0.001) in the TAVI and non-TAVI groups, respectively. CA-AKI was observed in 22.84% (37/162) of the TAVI group, and in 6.28% (45/716) of the non-TAVI group (p<0.001).

Conclusion: TAVI candidates have a higher risk of developing CA-AKI following the pre-procedural CT. Identification of CA-AKI risk factors in the TAVI patient population will allow clinicians to take preventative measures to reduce risk and improve prognosis.