1Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland
Background: Heart failure (HF) patients do often suffer of severe coronary artery disease (CAD). These HF patients are often multimorbid, at high operative risk and therefore more frequently offered for coronary high-risk interventions (HRI). One important complication of coronary intervention is acute kidney injury (AKI). Known risk factors are chronic kidney disease, nephrotoxicity of contrast agents and limited hemodynamics during coronary procedure. HF patients are thought to be at higher risk for AKI. The evaluation of the role of left ventricular ejection fraction (LVEF) as a predictor for AKI in HF patients undergoing HRI was the aim of the study.
Methods: In a consecutive five-year follow-up between 2016 and 2020 a total of 620 patients underwent HRI according to our previously published NOVA-HRI algorithm. Patients with extracorporeal membrane oxygenation and cardiogenic shock were excluded from the analysis. 361 HF patients were included and classified into three subgroups [HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), HF with preserved ejection fraction (HFpEF)] based on current ESC guideline. All HF patients were investigated for occurrence and severity of AKI according KDGIO recommendations.
Results: The overall occurrence of AKI in HF patients was 13.9% (n=50). In further analysis, AKI was more frequent in patients with HFrEF 19.4% vs. HFpEF 10.4% (p<0.05) but not between HFrEF 19.4% vs. HFmrEF 15.7% (p>0.05). Severe AKI (AKI stage II + III) was low with 1.6% overall. There was no significant difference for occurrence of AKI in HF patients with moderate to severe chronic kidney disease (CKD) ≥ stage 3 comparing HFrEF 26.7% vs. HFpEF 13.3%, (p=0.085) and HFmrEF 24.2% vs. HFpEF 14.5%, (p=0.254). The amount of used contrast agent did not differ between subgroups. The use of percutaneous micro-axial left ventricular assist device (Impella®) showed significantly (p<0.05) lower rates for occurrence of AKI in HFrEF patients (with support 14.3% vs. without support 21.5%) but HFpEF patients did not benefit (with support 12.9% vs. without support 9.2%).
Conclusion: Patients with HF undergoing HRI were at high risk for AKI. Overall, the occurrence of severe AKI was low. The use of percutaneous left ventricular assist device was associated with lower rates of AKI in HFrEF patients but not in patients with HFpEF.