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Coronary artery bypass grafting in non-dialysis-dependent mild-to-moderate renal dysfunction
A Weerasinghe1, P Hornick, P Smith
1Department of Cardiothoracic Surgery, Imperial College School of Medicine, University of London, Hammersmith Hospital, London W12 0HS, United Kingdom. aweerasinghe@ic.ac.uk
The Journal of Thoracic and Cardiovascular Surgery
|June 1, 2001
Summary
Mildly elevated preoperative serum creatinine levels significantly increase the risk of complications and mortality following coronary artery bypass grafting (CABG). Higher creatinine levels correlate with greater need for renal support and longer hospital stays.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Preoperative serum creatinine levels are a known risk factor in cardiac surgery.
- The impact of mild-to-moderate elevations in preoperative serum creatinine on morbidity and mortality after coronary artery bypass grafting (CABG) requires further investigation in large-scale studies.
- Understanding these effects is crucial for optimizing patient care and surgical planning.
Purpose of the Study:
- To evaluate the association between mild-to-moderate preoperative serum creatinine elevations and postoperative outcomes in CABG patients.
- To identify patient-specific variables that contribute to increased serum creatinine levels following CABG.
- To assess the need for mechanical renal support, duration of special care and hospital stay, complication rates, and in-hospital mortality.
Main Methods:
- A cohort of 1427 patients undergoing first-time CABG with cardiopulmonary bypass were analyzed.
- Patients were stratified into three groups based on preoperative serum creatinine levels: <130 µmol/L, 130-149 µmol/L, and ≥150 µmol/L.
- Multivariable stepwise logistic regression analysis was employed to identify significant predictors of outcomes.
Main Results:
- Elevated preoperative serum creatinine (≥130 µmol/L) significantly increased the likelihood of requiring mechanical renal support, extended special care, and prolonged total hospital stay (P<.001).
- In-hospital mortality showed a significant increase with creatinine levels of 130-149 µmol/L (P=.045) and ≥150 µmol/L (P<.001).
- Hypertension, advanced angina class, nonelective surgery, and prolonged cardiopulmonary bypass time were associated with increased postoperative serum creatinine levels.
Conclusions:
- Even mild elevations (130-149 µmol/L) in preoperative serum creatinine significantly elevate the risk of mechanical renal support, prolonged hospital stays, and in-hospital mortality after CABG.
- Higher preoperative creatinine levels (≥150 µmol/L) result in more pronounced adverse effects.
- The method of myocardial protection (cardioplegia vs. crossclamp fibrillation) did not significantly impact the studied outcomes.