The effect of the time interval between coronary angiography and on-pump cardiac surgery on risk of postoperative acute kidney injury: a meta-analysis

Abstract

BackgroundReports of the association between the time interval from coronary angiography (CAG) to cardiac surgery and risk of postoperative acute kidney injury (AKI) are controversial. We attempted to examine this association by conducting a meta-analysis.MethodsWe searched the Pubmed, MEDLINE, EMBASE, Web of Science databases, and the Cochrane Library from January 1966 to March 2013. A meta-analysis of studies reporting data for 1-day and 3-day time intervals between CAG and cardiac surgery was conducted after evaluation of heterogeneity and publication bias. Study-specific estimates were combined with inverse variance-weighted averages of logarithmic odds ratios (ORs) in fixed-effects models.ResultsFrom 8 studies involving 11542 persons, the pooled OR of AKI associated with an interval of 1 day or less between CAG and surgery was 1.21 (95% confidence interval (CI), 1.04 to 1.39) relative to an interval of more than 1 day. From 4 studies involving 5420 persons in the cardiopulmonary-bypass subgroup, the pooled OR of AKI associated with an interval of 3 days or less between CAG and surgery was 1.25 (95% CI, 1.07 to 1.43) relative to an interval of more than 3 days. The adjusted OR of the study in the cardiopulmonary bypass/ deep hypothermic circulatory arrest subgroup was 0.35 (95% CI, 0.17 to 0.73).ConclusionsA time interval of 1 day or less between CAG and on-pump cardiac surgery was significantly associated with increased risk of AKI. A delay of on-pump cardiac surgery until 24 hours after CAG can potentially decrease postoperative AKI.

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

“…Again, results in this area are contradictory. Intravenous contrast before surgery may increase the incidence of AKI and has led to some recommendations for delaying surgery 24 to 72 hours after contrast administration; however, another study disagrees . Preoperative placement of an intra‐aortic balloon pump may prevent AKI and reduce the incidence of RRT in high‐risk patients by improving perfusion and reducing endothelial activation .…”

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

“…Nevertheless, concerns persist in the surgical setting owing to the physiological insult of surgery potentially predisposing patients to the risk of contrast media, acting as a second hit that leads to AKI. Concerns regarding the risk of contrast‐induced nephropathy can have a significant impact on the patient care pathway, based on recommendations to undergo additional tests, withhold medications, enact protocols for periprocedural volume expansion, consider restricting use of contrast media, or potentially delay interventions.…”

A Patient with AKI after Cardiac Surgery

“…Studies on the association between the risk of postoperative AKI and the timing of contrast exposure before cardiac surgery have shown mixed results. Some studies have shown that the risk of AKI after CABG is inversely related to the time between cardiac angiography and CABG, including one recent meta-analysis that found that a time interval of 1 day or less between angiography and on-pump cardiac surgery was associated with increased risk of AKI (8,9). Others have reported no increased risk of AKI based on timing of contrast (10).…”