Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study

Abstract

Background: Post-procedural acute kidney injury (AKI) is associated with significantly increased short- and long-term mortalities, and renal loss. Few studies have compared the incidence of post-procedural AKI and in-hospital mortality between 2 major modalities of revascularization - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - and results have been inconsistent. Methods: We generated a propensity score-matched cohort that includes a total of 286,670 hospitalizations with multi-vessel coronary disease undergoing CABG or PCI (2004-2012) from the National Inpatient Sample database. We compared incidence of AKI, AKI requiring renal replacement therapy (RRT), in-hospital mortality, hospital stay, and charges between CABG and PCI groups. Results: The incidence of AKI after CABG was higher than PCI (8.9 vs. 4.5%, OR 2.05, 95% CI 1.99-2.12, p < 0.001). The incidence of AKI requiring RRT was also higher after CABG (1.1 vs. 0.5%, OR 2.14, 95% CI 1.96-2.34, p < 0.001). Likewise, in-hospital mortality was higher after CABG than PCI (2.0 vs. 1.4%, OR 1.44, 95% CI 1.35-1.52, p < 0.001). Among patients with pre-existing chronic kidney disease (stages I-IV), those undergoing CABG was associated with 2.0-2.3-fold higher odds of developing AKI than those undergoing PCI. The patients treated with CABG had a significantly longer hospital stay and higher hospital charges. Conclusions: Patients undergoing CABG are associated with (1) increased risk of developing post-procedural AKI, (2) higher likelihood of receiving RRT, and (3) worse short-term survival. Long-term renal outcome remains to be studied.

Multivessel Coronary Revascularization Strategies in Patients with Chronic Kidney Disease: A Meta-Analysis

“…Furthermore, we should pay attention to acute kidney injury, even though our research did not demonstrate any incidence of acute kidney injury. Shen et al [53] found that the incidence of AKI after CABG was higher than after PCI (8.9 vs. 4.5%; OR, 2.05; 95% CI, 1.99–2.12; p < 0.001), which reminded us to pay more attention to protecting the kidneys during the perioperative period.…”

Acute kidney injury following coronary revascularization procedures in patients with advanced CKD

“…Patients with multiple comorbidities and those with advanced CKD are often excluded from clinical trials or cardiovascular interventional studies because of a higher risk of complications and adverse events, making retrospective studies the sole source of information. Large retrospective studies comparing AKI following CABG versus PCI reported 1.6-, 2.6-and 2fold higher risks of AKI after CABG compared with PCI [16,17], and a higher incidence of AKI in patients with CKD compared with patients with normal kidney function, with an incrementally higher frequency of AKI in patients with more advanced stages of CKD [16,17]. Contrasting these findings, another VA-based study [14] described a relatively higher incidence of AKI after cardiac surgery in patients with baseline eGFR >45 mL/min/1.73 m 2 compared with baseline eGFR <45 mL/min/1.73 m 2 .…”

“…AKI is associated with high in-hospital and long-term mortality and with progression to ESRD [12][13][14][15]. The incidence of AKI has been found to be higher after CABG compared with PCI in patients with normal kidney function and with mild and moderate CKD [16,17]. However, the relative risk of AKI associated with CABG versus PCI in patients with advanced CKD (who may be more susceptible to radiocontrast-associated AKI) is unclear.…”

Preoperative blood morphology and incidence of acute kidney injury after on-pump coronary artery bypass grafting – a single-center preliminary report

“…The AKI rate in our preliminary report is within this range but rather close to the upper limited reported by other authors. It must be noted that the incidence seems to be higher in prospective single-center analyses [ 11 – 13 ] than in retrospective cohort studies of large national databases [ 14 , 15 ]. In the latter it may be underestimated and underreported as it based predominantly on analyses of the medical records where AKI was identified using International Classification of Diseases, 9 th Revision diagnosis codes.…”