Document Detail


Relationship of the time interval between cardiac catheterization and elective coronary artery bypass surgery with postprocedural acute kidney injury.
MedLine Citation:
PMID:  21911805     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Some prior studies have suggested that the time to cardiac surgery after cardiac catheterization is inversely related to postoperative acute kidney injury (AKI). However, these studies, because of the small number of patients, were unable to adequately account for patient case-mix and included both those undergoing elective surgery and those undergoing urgent surgery.
METHODS AND RESULTS: We examined data on 2441 consecutive patients undergoing elective coronary artery bypass surgery (CABG) after cardiac catheterization. The association of post-CABG AKI (defined as increase in post-CABG serum creatinine ≥ 50% above baseline or the need for new dialysis) and time between cardiac catheterization and CABG was evaluated using multivariable logistic regression modeling. AKI occurred in 17.1% of CABG patients. The risk of AKI was highest in patients in whom CABG was performed ≤ 1 day after cardiac catheterization (adjusted mean rates [95% CI]: 24.0% [18.0%, 30.9%], 18.4% [14.8%, 22.5%], 17.3% [13.3%, 21.9%], 16.4% [12.6%, 20.8%], and 15.8% [13.7%, 18.0%] for days ≤ 1, 2, 3, 4, and ≥ 5, respectively; P=0.019 for test of trend). Post-CABG AKI was associated with increased risk of long-term death (hazard ratio 1.268, 95% CI 1.093, 1.471).
CONCLUSIONS: The risk of post-CABG AKI was inversely and modestly related to the time between cardiac catheterization and CABG, with the highest incidence in those operated ≤ 1 day after cardiac catheterization despite their lower risk profile. Whether delaying elective CABG >24 hours of exposure to contrast agents (when feasible) has the potential for decreasing post-CABG AKI remains to be evaluated in future studies.
Authors:
Rajendra H Mehta; Emily Honeycutt; Uptal D Patel; Renato D Lopes; Judson B Williams; Linda K Shaw; Sean M O'Brien; Robert M Califf; G Chad Hughes; Michael H Sketch
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Circulation     Volume:  124     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-13     Completed Date:  2011-11-03     Revised Date:  2013-07-24    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S149-55     Citation Subset:  AIM; IM    
Affiliation:
Duke Clinical Research Institute, Box 17969, Durham, NC 27715, USA. mehta007@dcri.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Kidney Injury / epidemiology*
Aged
Cardiac Catheterization*
Coronary Angiography
Coronary Artery Bypass / adverse effects*
Coronary Artery Disease / radiography*,  surgery*
Female
Follow-Up Studies
Humans
Logistic Models
Male
Middle Aged
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K23 DK075929/DK/NIDDK NIH HHS; U01 HL088953/HL/NHLBI NIH HHS
Comments/Corrections

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