Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery

Tecson, Kristen M.; Brown, David L.; Choi, James W.; Feghali, Georges; González-Stawinski, Gonzalo V.; Hamman, Baron L.; Hebeler, Robert F.; Lander, Stuart R.; Lima, Brian; Potluri, Srini; Schussler, Jeffrey M.; Stoler, Robert C.; Velasco, Carlos; McCullough, Peter A.

doi:10.1016/j.athoracsur.2018.01.010

Cited by 21 publications

(9 citation statements)

References 34 publications

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“…19 This study did not detect any increased incidence of acute kidney injury (AKI), but other larger scale studies that retrospectively examined patients undergoing same-day coronary angiography and any cardiac surgery (ie, not just MV surgery) have demonstrated increased risk of AKI after intravenous contrast administration. [20][21][22] These studies have found that risk of AKI is significantly decreased by waiting for at least 5 days, with one of the studies recommending a waiting period of 5 days for urgent cases, and 2 weeks for elective cases. 20 Another retrospective study examined the outcomes of PCI and MV surgery performed on separate days.…”

Section: Staged Proceduresmentioning

confidence: 99%

Ischemic Mitral Regurgitation: Repair, Replacement or Nothing

Nonaka

Fox

2018

Semin Cardiothorac Vasc Anesth

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The treatment strategy for ischemic mitral regurgitation (MR) continues to evolve with the completion of multicenter trials and the advancement of surgical and percutaneous interventional techniques. This review defines ischemic MR, outlines key clinical trials that assess surgical and interventional approaches, and reports the main elements of recent national guidelines for decision making in treatment of ischemic MR. New findings in percutaneous mitral valve repair and replacement for ischemic MR will also be described. Effective perioperative care of patients with ischemic MR requires clinicians to be well versed in the most up-to-date recommendations and emerging technological developments.

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Section: Staged Proceduresmentioning

confidence: 99%

Ischemic Mitral Regurgitation: Repair, Replacement or Nothing

Nonaka

Fox

2018

Semin Cardiothorac Vasc Anesth

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“…Revascularization in patients with CTO is a challenging procedure, frequently necessitating longer procedural time and larger volume of iodinated contrast [17]. The CTO procedure in some circumstances where it is part of multivessel revascularization is an alternative to coronary artery bypass surgery which has been shown to add independent additional risks to the antecedent angiographic procedure [18]. Patients undergoing percutaneous coronary intervention for CTO with pre-existing CKD may experience adverse outcomes such as AKI [19, 20] and could benefit from a risk mitigation strategy comprising screening patients for risk factors, optimizing periprocedural hydration and managing the volume of contrast.…”

Section: Discussionmentioning

confidence: 99%

Major Adverse Renal and Cardiovascular Events following Intra-Arterial Contrast Media Administration in Hospitalized Patients with Comorbid Conditions

McCullough

Ryan³

et al. 2021

Cardiorenal Med

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Introduction: Several clinical studies and meta-analyses have demonstrated lower incidence of adverse renal and cardiovascular outcomes associated with the use of iso-osmolar contrast media (IOCM) than low-osmolar contrast media (LOCM) in patients with variable risk profiles undergoing intra-arterial interventional procedures. However, the association of contrast-type and major adverse renal and cardiovascular events (MARCE) has not been studied via comprehensive and robust real-world data analyses in patients with comorbid conditions considered at risk for post-procedural acute kidney injury (AKI). The objective of this study was therefore to retrospectively assess the MARCE rates comparing IOCM with LOCM in at-risk patients receiving iodinated intra-arterial contrast media using a real-world inpatient data source. Methods: Patients who underwent a diagnostic or treatment procedure with intra-arterial IOCM or LOCM administration were identified using the Premier Healthcare Database. Patient subgroups including those with diabetes, heart failure, chronic kidney disease (CKD) stages 1–4, CKD 3–4, or diagnosis of chronic total occlusion (CTO) were formed. Subgroups with combinations of diabetes and CKD 3–4 with and without CTO were also investigated. We compared the primary endpoint of MARCE (composite of AKI, AKI requiring dialysis, acute myocardial infarction, stroke/transient ischemic attack, stent occlusion/thrombosis, or death) after IOCM versus LOCM administration via adjusted multivariable regression analyses. Results: A total of 536,013 inpatient visits met the primary inclusion and exclusion criteria (IOCM = 133,192; LOCM = 402,821). After multivariable modeling, the use of IOCM was associated with a significantly lower incidence of MARCE than LOCM in patients with CKD 1–4, CKD 3–4, diabetes, or heart failure, with greatest absolute risk reduction (ARR) of 2.4% (p < 0.0001) in CKD 3–4 patients (relative risk reduction [RRR] = 13.8%, number needed to treat [NNT] = 43). Additionally, ARR associated with IOCM increased to 3.5% (p < 0.0001) in patients with combined comorbidities of diabetes and CKD 3–4 (RRR = 19.1%, NNT = 29). Statistically significant risk reduction was also found for the use of IOCM among patients who underwent revascularization for CTO (ARR = 1.6% [p < 0.0001], RRR = 22.3%, NNT = 62). Conclusion: Intra-arterial administration using IOCM in at-risk patients is associated with lower rates of MARCE than the use of LOCM. This difference is especially apparent in patients with a combination of CKD 3–4 and diabetes and in patients with CTO, providing real-world data validation with meaningful NNT in favor of IOCM.

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“…Tecson and colleagues in a study on 965 patients who had coronary angiography followed by cardiac surgery found that 13.1% had contrastinduced acute kidney injury; 13.8% had major adverse renal and cardiac events within 30 days and 26.2% within 1 year of surgery. They reported that patients undergoing coronary artery bypass graft surgery within one day of coronary angiography had a twofold increment in the risk of adverse cardiac and renal complications [15].…”

Section: Discussionmentioning

confidence: 99%

The relation between the timing of coronary angiography and renal function post coronary artery bypass grafting

Resk

Mohammed

Emara

2020

Egypt. Cardiothoracic. Surg.

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Background: Acute kidney injury is a serious complication after coronary artery bypass grafting (CABG). This work aimed to assess the impact of the timing of coronary angiography on kidney function after on-pump coronary artery bypass grafting. Methods: We included 60 patients who underwent elective isolated on-pump coronary artery bypass grafting from 2017 to 2018 at the National Heart Institute and Benha University Hospital. We divided the patients into two groups; group І included 30 patients with coronary angiography performed less than seven days prior to CABG, and Group ІІ included 30 patients who had coronary angiography more than seven days prior to CABG. Postoperative acute kidney injury was defined according to the consensus kidney disease: Improving Global Outcomes Definition and Staging criteria. Results: The mean body mass index was significantly higher in group I (35.89±5.15 Kg/ m² vs. 31.72±4.99 Kg/ m², P = 0.002). The mean preoperative hemoglobin was higher in group II (12.7 ± 1.5 g/dl vs. 13.9 ± 1.5 g/dl, P = 0.004). The frequency of acute kidney damage was higher in patients who had coronary angiography less than seven days before CABG but did not reach a significant level (46.7 % vs. 30%, P =0.184). There was no difference in the creatinine postoperatively between both groups (1.2 ±0.5 vs. 1 ±0.3 mg/dl; p= 0.214). Conclusions: We found no association between the timing of coronary angiography before on-pump coronary artery bypass graft surgery and postoperative acute kidney injury.

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Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery

Abstract: Patients who had contrast-induced acute kidney injury and had cardiac surgery within 1 day of angiography had an increased risk of MARCE.

Cited by 21 publications

References 34 publications

Ischemic Mitral Regurgitation: Repair, Replacement or Nothing

Ischemic Mitral Regurgitation: Repair, Replacement or Nothing

Major Adverse Renal and Cardiovascular Events following Intra-Arterial Contrast Media Administration in Hospitalized Patients with Comorbid Conditions

The relation between the timing of coronary angiography and renal function post coronary artery bypass grafting

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